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Old  Age  Deferred 


THE  CAUSES  OF  OLD  AGE  AND  ITS  POSTPONEMENT 

BY  HYGIENIC  AND  THERAPEUTIC 

MEASURES 


Man  does  not  die. 
he  kills  himself. 


By 


ARNOLD     LORAND,    M.D. 


u», 


Carlsbad,   Austria 


Translated,  with  additions,  by  the  Author, 
from  the  Second  German  Edition 


PHILADELPHIA 

F.  A.  DAVIS  COMPANY,  Publishers 

1910 


RAo 


"t» 


It  10 


COPYRIGHT.  1910 

BY 

F.   A.   DAVIS  COMPANY 

[Registered  at  Stationers'  Hall,  London.  Eng.j 


Press  of    F.   A.    Davis    Company 

1914-16   Cherry  Street 

Philadelphia,  Pa. 


PREFACE. 


Whoever  takes  up  this  book  with  the  idea  that  the  aged  can 
be  transformed  into  sprightly  adolescents  will  be  disappointed. 
A  work  based  entirely  on  evidence  of  a  scientific  nature,  as  is  the 
present  volume,  cannot  have  such  an  end  in  view,  since  it  is 
altogether  unattainable — at  least  with  what  knowledge  is  now 
available. 

But  while  it  is  still  impossible  for  us  to  create  a  young  man 
out  of  an  old  one,  it  is  quite  within  the  bounds  of  possibility,  as  we 
shall  endeavor  to  'demonstrate  herein,  to  prolong  our  term  of 
youthfulness  by  ten  or  twenty  years.  In  other  words  we  need  no 
longer  grow  old  at  forty  or  fifty;  we  may  live  to  the  age  of 
ninety  or  one  hundred  years,  instead  of  dying  at  sixty  or  seventy. 
All  this  can  be  brought  about  by  the  observance  of  certain 
hygienic  measures,  and  by  improving  the  functions  of  a  certain 
few  of  the  glandular  structures  in  our  body,  provided  incurable 
organic  disorders  have  not  already  too  gravely  compromised  one 
or  more  of  our  main  organs. 

In  a  communication  to  the  Paris  Biological  Society,  pre- 
sented in  our  name  by  Dr.  Gley,  Professor  of  Physiology  at  the 
University  of  Paris,  and  in  an  address  delivered  before  the  Brus- 
sels Royal  Society  of  Medical  and  Natural  Sciences,  we  described 
old  age  as  a  chronic  disease  due  to  degeneration  of  the  glands 
with  internal  secretions  (hereinafter  frequently  referred  to  as  the 
ductless  glands),  of  the  thyroid,  the  sexual  glands,  and  the 
adrenals  in  particular.,    In  this  work  we  will  show  that  this 

Ciii) 


iv  Preface. 

degeneration  is  amenable  to  treatment,  just  as  are  chronic  diseases 
in  general. 

The  facts  herein  presented  are  illustrated  and  sustained  by 
numerous  experimental  and  clinical  observations.  Being  desirous 
of  proving  the  correctness  of  all  our  statements,  we  have  had  to 
enter,  sometimes  very  fully,  into  the  question  of  the  ductless 
glands,  in  order  to  point  out  the  marvelous  influence  they  exert 
upon  the  various  vital  functions. 

In  view  of  the  fact  that  the  ductless  glands  have  already 
been  treated  in  a  very  elaborate  and  exhaustive  manner  by  a  well- 
known  American  author,  Professor  C.  E.  de  M.  Sajous,  of  Phila- 
delphia, in  his  work  on  the  "Internal  Secretions"  (2  volumes) 
which  introduces  many  new  thoughts  and  important  discoveries, 
we  have  paid  particular  attention  to  the  thyroid  and  sexual  glands, 
which  we  have  carefully  studied  anatomically,  histologically, 
experimentally  and  clinically. 

Not  being  a  native  of,  or  even  resident  in,  either  America  or 
England,  though  possessed  of  a  fair  knowledge  of  the  English 
language — having  delivered  addresses  in  several  universities,  and 
before  numerous  medical  societies  in  the  United  States,  Canada, 
England,  and  Scotland — it  was  very  difficult  for  us  to  avoid 
idiomatic  errors.  We  take  great'  pleasure  in  acknowledging, 
therefore,  our  indebtedness  to  our  friend,  Col.  Frank  Haddan,  of 
London,  who,  being  impressed  with  the  importance  of  our  subject 
and  its  humanitarian  aspect,  kindly  volunteered  to  look  through 
our  manuscript  and  correct  most  of  our  errors  of  style  and 
grammar,  thereby  rendering  us  valuable  assistance.  Our  thanks 
are  also  due  to  Dr.  Leo  Rosenthal,  of  New  York,  for  the  adjust- 
ment of  many  technical  sentences. 

Every  one  will  admit  that  the  subject  treated  in  this  work  is 
not  an  easy  one.     It  might  be  urged  also  that  its  presentation 


Preface.  v 

here  is  based  on  entirely  novel  lines,  scientific  literature  on  old 

age  being  very  scarce. 

Considering  also  that  it  has  been  necessary  for  us  to  take  up 

questions  beyond  the  ordinary  sphere  of  a  medical  practitioner, 

sometimes  of  a  philosophical,  technical  and  physical  nature,  it  is 

to  be  expected  that  certain  imperfections  will  be  found.     But, 

whatever  may  be  the  opinion  of  the  reader,  he  will  not  deny  that 

none  should  fail  to  derive  some  benefit  from  the  numerous  hints 

we  have  given  for  the  preservation  of  health  and  prolongation  of 

life.     If  by  reason  of  our  advice  we  succeed  in  saving  but  a  single 

human  life  from  a  premature  grave,  our  aim  will  have  been 

attained. 

Dr.  Arnold  Lorand. 

Carlsbad,  Austria. 


CONTENTS. 


CHAPTER  I.  page 

On  the  Appearance  of  Symptoms  of  Old  Age  in  Young  Persons 1 

CHAPTER  II. 

On  the  Agencies  which  Govern  our  External  Appearance  and  the 
Nutrition  of  the  Tissues 11 

CHAPTER  III. 

On  the  Agencies  which  Govern  Immunity  Against  Infections  and 
Intoxications — The  Origin  of  Fever 21 

CHAPTER  IV. 

On  the  Agencies  that  Govern  the  Condition  of  the  Nervous  System 
and  Mentality   35 

CHAPTER  V. 

On  the  Influence  of  the  Sexual  Glands  upon  Vitality  and  Long 
Life    45 

CHAPTER  VI. 
On  Heredity  and  Longevity 55 

CHAPTER  VII. 

On  Means  which  can  Help  us  to  Determine  the  Probable  Duration 
of  Life 64 

CHAPTER  VIII. 
On  the  Causation  of  Old  Age 90 

CHAPTER  IX. 

The  Rational  Prevention  of  Premature  Old  Age  and  the  Treatment 

of  Old  Age 114 

(vii) 


viii  Contents. 


CHAPTER  X.  page 

The  Destruction  and  Elimination  of  Toxic  Products  from  the  Body 
and  Hygienic  Measures  for  the  Improvement  of  these  Functions.  134 

CHAPTER  XI. 

On  the  Destruction  of  Poisonous  Products  Through  the  Thyroid 
and  Parathyroid  Glands 138 

CHAPTER  XII. 
Hygiene  of  the  Thyroid  Gland 145 

CHAPTER  XIII. 

The  Destruction  of  Toxic  Products  by  the  Liver  and  the  Improve- 
ment of  its   Protective  Functions 149 

CHAPTER  XIV. 
The  Hygiene  of  the  Liver 155 

CHAPTER  XV. 
On  the  Destruction  of  Toxic  Products  by  the  Adrenals 159 

CHAPTER  XVI. 

Hygiene  of  the  Adrenals  and  of  the  Circulatory  System — A  Few 
Remarks  on  the  Cause,  Prevention,  and  Treatment  of  Arterio- 
sclerosis    164 

CHAPTER  XVII. 

The  Elimination  of  Toxic  Products  Through  the  Intestines  and  the 
Improvement  of  This  Function 170 

CHAPTER  XVIII. 
On  the  Prevention  and  Treatment  of  Habitual  Constipation 175 

CHAPTER  XIX. 
Hygiene  of  the  Intestines 182 

CHAPTER  XX. 

Hygiene  of  the  Intestines — A  Few  Remarks  on  the  Cause  and  Pre- 
vention of  Appendicitis 192 

CHAPTER  XXI. 
On  the  Elimination  of  Toxic  Products  Through  the  Kidneys 197 


Contents.  ix 

CHAPTER  XXII.  pace 

Hygiene  of  the  Kidneys,  and  the  Prevention  of  Renal  Disease 203 

CHAPTER  XXIII. 
On  the  Elimination  of  Toxic  Products  Through  the  Skin 209 

CHAPTER  XXIV. 
The  Hygiene  of  the  Skin — Air  Baths 215 

CHAPTER  XXV. 
On  Rational  Clothing 219 

CHAPTER  XXVI. 

Improved  Hygiene  of  the  Skin  and  Kidneys  through  Bathing — Foot- 
baths    231 

CHAPTER  XXVII. 
Hygiene  of  the  Skin  and  Kidneys  by  Means  of  Perspiration 237 

CHAPTER  XXVIII. 

On   Exercise,   Swedish   Gymnastics — Massage — Sport,   and   Walking 
and  Running  Exercise 244 

CHAPTER  XXIX. 
A  Few  Remarks  on  Cold  Feet — Their  Cause  and  Treatment 252 

CHAPTER  XXX. 
On  the  Benefits  of  Sunlight 255 

CHAPTER  XXXI. 

On  the  Advantages  of  an  Open  Air  Life  and  of  Breathing  Exer- 
cises    262 

CHAPTER  XXXII. 
On  the  Dangers  of  Living  in  Confined  and  III  Ventilated  Quarters.  271 

CHAPTER  XXXIII. 

Hygiene  of  Artificial  Heating — the  Dangers  of  Heat  by  Steam  and 
a  Few  Hints  about  their  Prevention 275 

CHAPTER  XXXIV. 
Food  Hygiene — General   Remarks 280 


x  Contents. 

CHAPTER  XXXV.                                          page 
On  Proteid  Food,  Animal  Food,  Meat,  Fish,  Eggs,  Milk,  etc 294 

CHAPTER  XXXVI. 

On  Carbohydrates   and  Fats,   and  the  Great  Advantages  of  Vege- 
tables and  Fruit 301 

CHAPTER  XXXVII. 
On  the  Advantages  and  Disadvantages  of  a  Vegetarian  Diet 309 

CHAPTER  XXXVIII. 

On  the  Dangers  of  a  Too  Abundant  Meat  Diet — A  Few  Hints  on 
the  Dietetics  of  Meat 317 

CHAPTER  XXXIX. 

On  the  Great  Advantages  of  Much  Milk  in  the  Diet  for  the  Pre- 
vention and  Treatment  of  Old  Age 325 

CHAPTER  XL. 

On  Blood  as  an  Article  of  Food  Containing  Iron  and  Animal  Ex- 
tracts— Sausages  and  Blood  Puddings 333 

CHAPTER  XLI. 

Some  Remarks  on  the  Hygiene  of  Eating — How  to  Obtain  an  Appe- 
tite— On  Mastication   339 

CHAPTER  XLII. 

On  the  Uses  of  Small  Doses,  and  the  Deleterious  Action  of  Large 
Quantities  of  Alcohol 347 

CHAPTER  XLIII. 
Some  Remarks  on  the  Causes  and  Prevention  of  the  Alcohol  Habit.  356 

CHAPTER  XLIV. 

On  Other  Stimulants — Tea,  Coffee,  Cocoa,  Tobacco:    Their  Merits 
and  Disadvantages   362 

CHAPTER  XLV. 
On  Sleep,  and  Its  Importance  in  Ridding  the  Body  of  Toxic  Products.  368 

CHAPTER  XLVI. 
On  the  Causation  of  Sleep,  Sleepiness,  and  Insomnia 372 


Contents.  xi 

CHAPTER  XLVII.                                          page 
Hygiene  of  Sleep — Prevention  of  Insomnia 377 

CHAPTER  XLVIII. 
The  Treatment  of  Sleepiness  and  Insomnia 383 

CHAPTER  XLIX. 

Hygiene  of  the  Sexual  Glands — the  Dangers  of  Sexual  Overactivity 
and  of  Total  Sexual  Abstinence 389 

CHAPTER  L. 
On  Married  Life  as  an  Important  Means  for  Prolonging  Life 400 

CHAPTER  LI. 
Hygiene  of  the  Mind — Emotions  and  Worry  as  Causes  of  Old  Age..  404 

CHAPTER  Lll. 

Hygiene  of  the  Mind — Religious  Belief  as  a  Means  of  Prolonging 
Life 414 

CHAPTER  LIU. 
Disease  Considered  as  a  Self-defence  of  Nature 419 

CHAPTER  LIV. 
Hygiene  of  the  Mind — Advice  to  Brain  Workers 423 

CHAPTER  LV. 

On  the  Prevention  of  Premature  Old  Age,  and  the  Treatment  of  Old 
Age,  through  Certain  Drugs  :   Arsenic,  Iron,  and  Iodides 426 

CHAPTER  LVI. 

On  the  Prevention  of  Premature  Old  Age  and  on  the  Treatment  of 
Old  Age  by  Animal  Extracts 434 

CHAPTER  LVII. 
A  Few  Hints  on  Youthful  Appearance 449 

CHAPTER  LVIII. 

The  "Twelve  Commandments-"  for  the  Preservation  of  Youth,  and 
the  Attainment  of  a  Green  Old  Age 455 


CHAPTER   I. 

On  the  Appearance  of  Symptoms  of  Old  Age  in 
Young  Persons. 

As  a  general  rule  the  first  symptoms  of  old  age  do  not 
appear  before  the  fortieth  or  forty-fifth  year.  There  are,  how- 
ever, many  persons  who,  much  earlier,  occasionally  even  before 
thirty,  show  some  of  the  typical  symptoms  of  senility:  corpu- 
lence, gray  hair,  wrinkles  in  the  face,  falling  out  of  the  hair  and 
loss  of  teeth,  etc.,  for  example.  The  gums  also  are  retracted  from 
the  teeth,  which  consequently  appear  greatly  lengthened ;  later 
on  the  teeth  become  loosened  and  fall  out.  This  then  causes  the 
jaw  bones  to  atrophy,  when  the  face  becomes  sunken,  and  the  indi- 
vidual appears  many  years  older.  The  hair  loses  its  original  color 
and  becomes  dry  and  gray,  especially  on  the  temples.  The  ap- 
pearance of  bald  spots  surrounded  by  gray  hair  increases  the  aged 
appearance  of  the  face.  On  examination,  the  pulse  of  such  per- 
sons may  exhibit  a  high  tension,  the  temporal  arteries  may  be 
tortuous,  and  the  skin  found  to  be  dry.  A  sensation  of  cold  in 
the  extremities  is  especially  frequent.  There  is,  as  a  rule,  a 
tendency  to  constipation.  The  mental  faculties  are  also  altered ; 
the  memory  weakens,  and  the  mind  is  often  depressed.  Neu- 
rasthenia or  hysteria  become  frequent  in  such  persons,  while 
impotence  in  men  and  menstrual  disorders  in  women  develop. 
The  urine  may  be  found  to  contain  traces  of  albumin  and  occa- 
sionally a  few  hyaline  casts.  The  presence  of  these,  according  to 
Professor  Senator,1  indicates  a  degeneration  of  the  convoluted 
tubules  of  the  kidneys,  and  thus  the  loss  of  important  elements 
of  the  chief  excretory  organ  of  the  human  body. 

On  examination  of  the  state  of  nutrition  in  these  persons, 

i  Hermann    Senator:       "Die    Erkrankungen    der    Nieren;"    Nothnagel's 
"Handbuch  der  praktischen  Medicin,"  ii  Auflage,  1902. 

(1) 


Old  Age  Deferred. 


it  may  often  be  found  to  be  below  the  normal.  It  is  certain  that 
such  a  condition  in  young  people  is  abnormal,  and,  therefore, 
a  pathological  condition. 

The  question  now  arises:  In  which  category  of  diseases  is 
this  condition  to  be  classified? 

In  typical  cases  of  this  class  there  is  a  diminution  of 
metabolism,  i.e.,  of  the  assimilation  and  conversion  of  food 
into  energy.  We  shall  have  to  think  of  the  possibility  of  altera- 
tions in  those  organs  which  govern  the  process  of  metabolism. 

These  organs  are  the  glands  with  internal  secretion  (espe- 
cially the  thyroid  gland,  testicles,  ovaries,  the  adrenals  and 
pituitary  body),  according  to  recent  researches,  among  which 
those  of  the  author  of  this  book  may  be  mentioned.  He  was 
among  the  first  to  show  the  fact  that  glands  with  internal  secre- 
tion control  all  the  processes  of  oxidation,2  and  that  the  dis- 
eases of  metabolism :  diabetes,  obesity,  gout,  etc.,  are  the  direct 
consequence  of  alterations  in  these  important  glands.  This  is 
further  sustained  by  the  labors  of  Sajous3  who  was  the  first 
to  describe  the  mechanism  through  which  these  organs  govern 
oxidation  and  metabolism,  and  to  explain  how  they  produce  the 
disorders  just  enumerated. 

The  most  important  part  herein  is  taken  by  the  thyroid 
gland,  whose  increased  activity  is  followed  by  an  augmenta- 
tion of  the  processes  of  oxidation  in  the  body,  whereas  its 
degeneration  is  followed  by  a  diminution  of  these  processes. 
When  the  thyroid  gland  is  degenerated  entirely,  as  in  myx- 
cedema,  there  is  also  a  great  diminution  of  all  oxidation  proc- 
esses. There  are  also  cases  where  the  thyroid  is  only  partially 
altered  by  the  increase  of  connective  tissue,  cases  called  partial 
myxcedema,  and  in  these  cases,  accordingly,  the  diminution  of  the 


2  Intern.  Congr.  of  Med.,  Madrid,  April,  1903;  and  various  Addresses  to 
the  Brussels  Royal  Society  for  Med.  and  Nat.  Sciences,  1903,  the  Hamburg 
Med.  Society,  1904,  the  Paris  Biolog.  Society,  1904,  the  London  Path.  Society, 
1905,  etc. 

3  Sajous :  "Internal  Secretions  and  the  Principles  of  Medicine,"  vol.  i, 
1903,  and  vol.  ii,  1907,  and  Philadelphia  Medical  Journal,  March  7,  1903. 


Symptoms  of  Old  Age  in  Young  Persons. 

processes  of  oxidation  does  not  take  place  to  the  same  extent  as  in 
complete  myxcedema. 

When  we  thus  find  symptoms  of  old  age  in  young  persons, 
together  with,  in  the  most  typical  cases,  a  state  of  decreased 
oxidation,  we  have  to  determine  whether  or  not  we  are  dealing 
with  a  degeneration  of  the  thyroid  gland.  And,  indeed,  such  a 
condition  is  before  us,  for  the  symptoms  we  have  just  mentioned 
are  characteristic  of  myxcedema. 

If  complete  myxcedema,  the  highest  degree  of  this  condi- 
tion, is  rare,  on  the  other  hand  the  incomplete  forms,  where  the 
thyroid  is  only  partially  replaced  by  connective  tissue,  are  fairly 
common. 

This  is  shown  by  the  fact  that,  after  the  fortieth  or  forty- 
fifth  year,  the  thyroid  shows  an  increased  amount  of  connective 
tissue,  and  thus  cannot  be  so  active  as  a  thyroid  with  more  secret- 
ing elements  and  less  connective  tissue. 

We  have  thus  reasons  to  suppose  that  the  persons  above 
mentioned,  who  only  exhibit  some  but  not  all  of  the  symptoms 
of  old  age,  symptoms  which  are  also  found  as  typical  in  myx- 
cedema, are  suffering  from  a  partial  myxcedema  or  hypothy- 
roidia.  And  it  does  not  necessarily  follow  that  in  all  such  cases 
the  processes  of  nutrition  will  be  diminished,  as  is  the  rule  in 
typical  cases  of  myxcedema. 

The  resemblance  between  senility  and  myxcedema  was  first 
pointed  out  in  1890  by  Sir  Victor  Horsley,  one  of  the  foremost 
authors  on  myxcedema,  and  afterward  by  Vermehren,4  Ewald,5 
of  Berlin,  and  the  author.  Horsley  ascribed  old  age  to  degen- 
eration of  the  thyroid  gland,  and  we  have  shown  (in  a  com- 
munication to  the  Paris  Biological  Society,  presented  by  Dr. 
Gley,  Professor  of  Physiology  at  the  University  of  Paris,  Decem- 
ber 4,  1904)  that,  besides  the  thyroid,  there  are  also  different 
other  ductless  glands  whose  degeneration  produces  old  age. 
These  are  the  sexual  glands,  the  pituitary  body,  and  the  adrenals. 

4  Over  Myxoedemet,  Kjobenhavn,  1895. 

5  Ewald :     "Die  Erkrankungen  der  Schilddriise,"  Nothnagel's  Handbuch, 
Vienna,  1896. 


Old  Age  Deferred. 


It  is  a  well-known  fact  that  extirpation  of  the  testicles  and 
of  the  ovaries  is  followed  by  obesity  and  other  symptoms  of 
old  age;  in  the  same  way  cessation  of  the  menstruation  with 
degeneration  of  the  ovaries  at  the  climacteric  is  followed  by  all 
the  symptoms  of  old  age  and  certain  nervous  disturbances,  as,  for 
instance,  troublesome  flushings,  which  occur  here,  as  after  cas- 
tration. Eunuchs,  as  a  rule,  look  much  older  than  their  age. 
The  Oriental  eunuchs,  and  also  the  members  of  a  religious  caste 
in  Russia,  the  Skopse,  who  castrate  themselves  through  fanati- 
cism, because  of  their  parchment-like  face  covered  with  innumer- 
able wrinkles,  appear  aged  beyond  their  years. 

Degeneration  of  the  pituitary  body  is  also  followed  by  pre- 
mature senility.  This  is  shown  by  the  fact  that  acromegalic 
persons,  as  a  rule,  look  much  older  than  their  age.  This  also 
holds  good  in  the  case  of  myxoedematous  patients.  We  have 
had  opportunity  to  see,  quite  recently,  the  skeleton  of  a  female 
acromegalic  patient  of  Dr.  G.  A.  Gibson  in  Edinburgh,  and  found 
typical  indications  of  old  age,  an  enormous  augmentation  of 
connective  tissue  and  vascularization  of  the  bones,  with  great 
porosity. 

It  must  be  remembered  that  all  the  glands  with  internal 
secretions,  according  to  Pineles,6  Sajous,7  and  the  researches  of 
the  author,  stand  in  very  close  relation  to  one  another.  Thus, 
degeneration  of  the  thyroid  is  followed  by  that  of  the  pituitary 
body.  This  was  shown  by  the  experiments  of  Hofmeister,8 
Stieda,9  Rogowitsch,10  Benda,  and  many  others.  Degeneration 
of  the  pituitary  is  followed  by  a  similar  lesion  in  the  thyroid. 

Arteriosclerosis  is  a  condition  very  frequently  met  with  in 
elderly  persons,  and,  according  to  recent  researches,  this  disease 
is  caused  by  a  toxic  agent  with  subsequent  degeneration  of  the 
walls  of  the  blood-vessels.      Such   a  change   can   be  produced 

0  Pineles:     Volkmann's  klin.  Vortrage,  N.  242,  1899. 

7  Sajous:     "Internal  Secretions,"  Philadelphia,  vol.  i,  p.  140,  1903. 

8  "Beitrage  zur  klin.  Chirurgie,"  1894. 
o  Ziegler's  Beitrage,  Bd.  vii. 

lOZiegler's  Beitrage,  vol.  iv,  1889. 


Symptoms  of  Old  Age  in  Young  Persons.  5 

artificially,  as  shown  by  Josue,11  by  injecting  adrenal  extract 
into  rabbits. 

That  the  ductless  glands  are  closely  related  holds  good  also 
for  the  thyroid  and  adrenals.  This  relation,  however,  is  an 
antagonistic  one.  The  adrenals  increase  the  blood-pressure 
(Oliver  and  Schafer12),  and  the  thyroid  diminishes  it.  It  is 
an  interesting  fact,  demonstrated  by  Professor  Eiselsberg13  in 
Vienna,  that  extirpation  of  the  thyroid  gland  of  dogs  results  in 
atheroma  of  the  aorta.  In  connection  with  this  we  also  men- 
tion the  clinical  fact,  that  all  those  agencies  which  are  harmful 
to  the  thyroid  gland,  as  syphilis,  abundant  meat  food  (Brei- 
sacher,14  Blum,15  Lorand16),  alcohol  (Hertoghe  and  de  Quer- 
vain17),  and  tobacco  (Hertoghe),  are  also  those  which  are 
commonly  considered  to  be  the  causes  of  high  tension  and 
arteriosclerosis.  Infectious  diseases  are  also  brought  in  etiolog- 
ical relationship  with  arteriosclerosis,  and  it  has  been  shown  by 
a  series  of  authors,  that  in  infectious  diseases  the  thyroid  under- 
goes important  alterations  which  may  involve  its  degeneration 
(Roger  and  Gamier,  Crispino,  Torri,  Bayon,  de  Quervain). 

Infectious  diseases  also  induce  changes  in  the  adrenals,  as 
shown  by  many  authors  (see  Chapter  III). 

Various  toxic  products,  such  as  lead,  alcohol,  and  tobacco, 
which  are  considered  causes  of  arteriosclerosis,  are  also  able  to 
produce  hypertrophy  of  the  adrenals. 

And,  if  we  consider  those  agencies  which  are  commonly  con- 
sidered the  causes  of  premature  senility,  we  notice  the  singular 
fact  that  they  are  also  considered  to  be  especially  harmful  to 
the  various  glands  with  internal  secretion,  particularly  the  thy- 
roid and  sexual  glands. 

11  Josue:     C.  R.  Societe  de  biologie,  Nov.  14,  1903. 

12  Oliver  and  Schafer:     Journal  of  Physiology,  vol.  xviii,  1895. 

13  Eiselsberg:     "Die  Krankheiten  der  Schilddriise,"  Stuttgart,  1901. 

14  Breisacher:     Archiv  fur  Anat.  und  Physiologie,  Suppl.,  Bd.,  p.  509,  1890. 

15  Blum:     Virchow's  Archi^  p.  495-514,  1899. 

16 Lorand:     Transactions  of  the  Path.  Society  of  London,  vol.  lvii,  Part 
1,  1906. 

17  La  Semaine  Medicale,  1905. 


6  Old  Age  Deferred. 


Among  these  agencies  may  be  mentioned  infectious  diseases, 
sexual  excesses,  frequent  pregnancies,  strong  emotions  continued 
for  a  long  time,  such  as  grief  and  sorrow,  chronic  intoxications 
(by  poisonous  products  produced  in  the  body,  or  introduced  from 
without).  We  will  show  later,  in  an  exhaustive  way,  the  action 
of  these  agencies  upon  the  glands  with  internal  secretion. 

Between  the  thyroid  gland  and  the  ovaries,  a  close  rela- 
tionship also  exists.  Thus,  invariably,  when  we  find  the  thyroid 
altered,  we  can  also  see  changes  in  the  ovaries.  Consequently 
in  myxcedema  and  Graves's  disease  we  find,  with  great  fre- 
quency, disturbances  in  the  functions  of  the  ovaries,  e.g.,  cessa- 
tion of  the  menses,  or  disorders  of  menstruation.  In  such  con- 
ditions the  ovaries  have  often  been  found  to  be  atrophied.  We 
also  frequently  find  such  disturbances  in  acromegaly,  where  they 
may  either  be  due  to  changes  in  the  pituitary,  associated  with  an 
altered  condition  of  the  ovaries,  or  they  may  be  ascribed  directly 
to  changes  in  the  thyroid  which,  as  we  have  shown  in  a  commu- 
nication to  the  International  Congress  in  Madrid,  1903,  is  very 
often  altered  in  acromegaly.  If  microscopically  examined  it 
is  probably  found  changed  in  every  case.  Indeed,  we  have 
attributed  acromegaly  to  the  primary  changes  in  the  thyroid 
which  lead  only  secondarily  to  those  in  the  pituitary  body. 

In  diabetes,  which  disease,  according  to  our  investigations, 
is  often  caused  by  changes  in  the  thyroid,18  and  subsequently 
in  the  pancreas,  or  vice  versa,  amenorrhea  or  impotency  is 
frequently  met  with. 

On  the  other  hand,  changes  in  the  ovaries  are  also,  as  a 
rule,  followed  by  changes  in  the  thyroid  gland,  as  may  be  seen 
in  puberty,  menstruation,  pregnancy,  lactation,  and  the  climac- 
teric. We  will  enlarge  upon  this  later,  in  greater  detail,  but  we 
will  only  briefly  mention  here  that  we  may  frequently  see  a 
swelling  of  the  thyroid   gland   as   an   expression   of   increased 


18  Lorand :  "Die  Entstehung  der  Zuckerkrankheit  und  ihre  Beziehungen 
zu  den  Veranderungen  der  Blutgefassdriisen,"  Berlin,  A.  Hirschwald,  1903,  and 
French  Translation^  Maloine,  Paris3  1904. 


Symptoms  of  Old  Age  in  Young  Persons.  7 

activity  during  these  conditions.  We  can  also  see  this  in  dis- 
eases of  the  ovaries,  and,  as  certain  authors  show,  even  sexual 
excesses  can  produce  an  altered  state  of  the  thyroid.  This  was 
known  to  the  ancient  Hebrews,  for  they  used  to  examine  the 
neck  of  the  newly-married  bride  the  morning  following  the  wed- 
ding night  to  see  if  the  neck  had  become  larger  by  the  swelling 
of  the  thyroid  gland. 

Thus  we  can  readily  understand  that,  frequently,  swelling 
of  the  thyroid  is  the  consequence  of  over-work  of  this  organ, 
and,  as  in  the  case  of  great  sexual  excesses  or  frequent  pregnan- 
cies, may  lead  to  exhaustion  of  the  gland  with  its  grave  clinical 
consequences. 

Indeed  it  has  been  shown  by«  the  earliest  authors  on  myx- 
cedema,  that  this  disease  is  very  frequently  caused  by  too  fre- 
quent pregnancies,  especially  if  connected  with  prolonged  lacta- 
tion (Ord,  Morvan,  Combe).  This  will  also  explain  why  women 
more  frequently  show  the  symptoms  of  precocious  senility  than 
men,  whose  sexual  glands  are  not  put  to  such  constant  activity 
and  change  as  are  the  female  sexual  glands.  Similarly  women, 
after  frequent  pregnancies,  especially  with  prolonged  lactation, 
or  women  with  diseases  of  the  ovaries,  and  also  those  addicted 
to  habitual  sexual  excess,  such  as  prostitutes,  very  soon  become 
fat  and  fade  before  their  time.  Thus  we  may  see  symptoms  of 
precocious  senility  in  such  women  even  before  the  end  of  the  third 
decade,  especially  if  they  have  begun  to  lead  an  immoral  life  at 
an  early  age.  Even  young  girls  may  look  much  older  through  the 
abuse  of  their  ovaries  from  sexual  excesses.  Their  breasts  be- 
come large  and  pendulous,  and  their  faces  bloated  and  relaxed. 
Menstruation  may  likewise  be  made  to  appear  in  early  childhood 
by  sexual  abuses,  as  Pauline  Tarnowska18a  has  found  through  the 
examination  in  St.   Petersburg  of   150  very  young  prostitutes. 

We  shall  show  in  the  next  chapter  that  obesity,  which  has 
nothing  to  do  with  over-feeding,  can  be  caused  by  like  agencies. 


I8a  Tarnowska :      "Etudes    antropometriques    sur    les    prostitutees    et    les 
voleuses,"  Paris,  1889. 


8  Old  Age  Deferred. 


That  mental  emotions,  especially  care,  grief,  sorrow,  etc., 
powerfully  influence  the  different  ductless  glands,  and  are  able 
to  produce  degeneration  of  the  thyroid,  adrenals,  and  sexual 
glands,  etc.,  is  shown  by  conclusive  proofs  in  the  chapter  on  the 
"Hygienics  of  the  Mind." 

Infectious  diseases  are  especially  liable  to  cause  change  in 
the  kidneys,  and  in  various  infectious  diseases,  sometimes  even 
in  tonsillitis,  we  may  find  an  inflamed  condition  of  these  organs. 

The  kidneys  can  also  be  damaged  by  the  passage  of  various 
toxic  products,  which  are  either  produced  in  the  body  (auto- 
intoxication) or  introduced  with  the  food  (condiments),  or  as 
stimulants — e.g.,  alcohol,  strong  tea,  etc.  All  these  toxic  agents 
are  capable  of  doing  damage  to  the  kidneys  just  as  to  the  thy- 
roid gland.  We  shall  treat  later  on,  in  separate  chapters,  of  the 
action  of  these  stimulants  upon  the  ductless  glands. 

The  condition  termed  auto-intoxication  may  be  induced  by 
many  different  factors,  among  which  may  be  mentioned  the 
products  of  intestinal  putrefaction  (Senator19)  and  the  waste 
products  from  the  processes  of  oxidation,  such  as  uric  acid,  for 
example.  Animal  food  is  more  apt  to  produce  intestinal  putre- 
faction than  any  of  the  various  other  foodstuffs. 

There  are  three  important  organs  which  protect  us  against 
such  a  condition  of  auto-intoxication;  these  are  the  kidneys, 
liver,  and  thyroid,  and  possibly  also  the  parathyroids. 

The  kidneys  act  by  promptly  eliminating  such  toxic  products 
in  the  urine.  They  are  glands  with  internal  secretion,  as  shown 
by  the  experiments  of  Brown-Sequard,20  E.  Meyer,21  and  clin- 
ical observations  of  Senator22  and  H.  Strauss. 

The  liver,  which,  according  to  Gilbert,  H.  Strauss,23  and 
others,  is  also  a  gland  with  an  internal  secretion,  is  strongly  an- 
tagonistic   to    intestinal    poisons.      It    destroys    toxic    products 


19  Senator:     Berliner  klin.  Wochenschrift,  Nu.  24,  1868. 

20  Brown-Sequard :     Archives  de  physiologie  norm,  et  path,  p.  778,  1893. 

21  E.  Meyer:     Ibid.  p.  179,  1894. 

22  Senator :     hoc.  cit. 

23  H,  Strauss,  Senator :     Festschrift. 


Symptoms  of  Old  Age  in  Young  Persons.  9 

brought  to  it  from  the  intestine  through  the  portal  vein,  and  sev- 
eral authors,  Professor  Adami,  Sir  Lauder  Brunton  and  Boken- 
ham,24  show  that  it  is  also  able  to  eliminate  such  products  with  the 
bile  after  previous  transformation.  We  will  treat  of  these  pro- 
tective functions  of  the  liver  in  a  separate  chapter,  together  with 
the  hygienics  of  this  important  organ;  but  we  will  just  men- 
tion here  that  the  liver  plays  a  great  role  in  the  transformation 
of  the  toxic  end  products  of  albuminous  food  into  harmless  sub- 
stances, such  as  urea. 

The  third  important  toxin-destroying  organ  is  the  thyroid 
gland,  which,  as  shown  by  the  experiments  of  Dr.  Leo  Brei- 
sacher,2°  of  Detroit,  formerly  assistant  to  Professor  Munk,  of 
Berlin,  and  of  Dr.  F.  Blum,26  of  Frankfort,  as  well  as  Dr. 
Chalmers  Watson,27  of  Edinburgh,  destroys  those  poisonous 
substances  produced  by  the  decomposition  of  proteid  food.  More- 
over, Sajous  has  shown  that  this  is  a  prominent  function  of  the 
pituitary  body,  the  thyroid  and  the  adrenals,  acting  jointly  as 
the  "adrenal  system." 

It  will  be  evident  that  these  various  glands  can  only  do  their 
work  to  perfection  so  long  as  their  parenchymatous  tissue  is  not 
replaced  to  any  large  extent  by  connective  tissue.  Of  these  glands 
the  thyroid  takes  the  foremost  rank,  as  it  governs  the  other 
glands.  As  we  have  shown  in  a  communication  to  the  French 
Congress  of  Medicine,  in  Liege,  1905,  the  thyroid  influences 
the  liver,  and  in  a  paper  before  the  Paris  Biological  Society, 
February  25,  1907,  we  have  shown  that  the  thyroid  also  influ- 
ences the  kidneys.  In  fact,  the  liver  and  kidneys  are  closely 
allied  to  the  thyroid,  and  when  this  organ  is  degenerated,  the 
other  two  glands  follow  suit. 

Accordingly  we  may  expect  that,  when  the  thyroid  under- 
goes a  process  of  degeneration,  such  an  event  may  also  take  place 


24  Sir  Lauder  Brunton  and  Bokenham :      The  Journal   of  Pathology  and 
Bacteriology,  p.  50,  Nov.,  1907. 

25  Breisacher :     hoc.  cit. 

26  Blum:     Virchow's  Archiv,  1899. 

27  Lancet,  Feb.  11,  1905. 


10  Old  Age  Deferred. 


in  these  two  protective  organs,  as  we  have  shown  in  our  above- 
mentioned  two  communications.  In  consequence  of  the  dimin- 
ished activity  of  these  organs  the  development  of  a  condition 
of  auto-intoxication  may  be  facilitated.  Patients  showing  symp- 
toms of  old  age  in  early  years,  also  show  to  a  greater  or 
less  extent  symptoms  of  such  a  condition,  as  do  myxcedematous 
persons. 

Meat  food  especially,  if  taken  in  large  quantity,  is  a  certain 
producer  of  uric  acid,  and  it  is  an  interesting  fact,  shown  by 
several  authors  and  also  by  the  writer,28  that  by  thyroid  medica- 
tion we  can  augment  the  elimination  of  uric  acid,  and  also  pre- 
vent its  formation  in  large  quantity,  both  in  the  case  of  uric 
acid  formed  in  the  body  or  introduced  from  without  by  the  food. 

This  fact  stands  in  relation  to  the  powerful  influence  exer- 
cised by  the  ductless  glands,  and  especially  the  thyroid,  upon 
the  process  of  oxidation ;  and,  as  we  are  anxious  to  prove  the  as- 
sertions we  here  advance,  we  shall  show  in  the  next  chapter  how 
these  wonderful  glands  influence  the  processes  of  nutrition  in  the 
tissues,  and  at  the  same  time  the  external  appearance.  We  have 
already  mentioned  a  form  of  obesity  that  has  nothing  to  do  with 
overfeeding,  as  one  of  the  symptoms  of  precocious  old  age,  and 
in  the  next  chapter  we  will  review  in  detail  the  agencies  which 
govern  this  condition. 


28Lorand:      Comptes  Rendus  de  la  Societe  de  biologie  de  Paris,  Fevrier 
25,  1907. 


CHAPTER   II. 

On  the  Agencies  which  Govern  our  External  Appear- 
ance and  the  Nutrition  of  the  Tissues. 

As  a  general  rule  infants  of  both  sexes  look  very  much 
alike,  so  much  so,  indeed,  that  sometimes  it  is  only  possible,  upon 
close  inspection,  to  determine  the  difference  in  sex.  This,  how- 
ever, can  only  be  so  for  a  certain  period  until  certain  changes 
take  place  in  the  ductless  glands,  especially  in  the  sexual  glands 
and  the  thyroid. 

The  latter  contains  but  very  little,  if  any,  colloid  sub- 
stance in  infancy,  and  the  colloid  increases  only  gradually  until 
it  is  present  in  abundance  at  the  time  of  puberty,  when  also  the 
changes  in  the  sexual  glands  reach  a  climax  coincident  with  the 
ripening  of  the  follicles  in  the  ovaries  and  their  rupture  at  a 
menstrual  period.  This  latter  process  is,  as  we  have  mentioned 
before,  under  the  influence  of  the  thyroid.  Puberty  and  men- 
struation do  not  take  place,  as  a  rule,  in  persons  with  a  degen- 
erated thyroid  gland. 

With  the  onset  of  puberty  there  is  seen,  also,  a  change  in 
the  external  appearance  of  the  individual  and  the  attributes  of 
virility — e.g.,  moustache,  hair  in  the  pubic  region,  alteration  of 
the  voice,  etc.,  appear.  In  the  female  the  development  of  the 
breast,  hair  on  the  pubis,  etc.,  occurs.  At  the  same  time  the 
features  attain  the  peculiar  characteristic  which  distinguishes 
the  male  face  from  the  female,  even  without  the  aid  of  a  mous- 
tache. 

In  those  persons  in  whom  puberty  has  not  occurred  at  the 
usual  age  (fourteen  to  sixteen  years  in  our  climate)  the  attri- 
butes of  sex  are  absent.  In  these  cases  the  male  looks  very  much 
like  the  female.  A  similar  phenomenon  may  be  seen  in  women 
after  castration  and  the  climacteric,  when  they  may  even  show 

(11) 


12  Old  Age-  Deferred. 


a  tendency  to  develop  a  moustache  and  hair  on  their  face  in 
places,  corresponding  to  the  male  beard. 

This  we  can  also  observe  in  women  whose  ovaries  have  been 
altered  by  disease  or  by  sexual  excesses. 

These  attributes  of  sex  are  also  called  external  sexual  char- 
acteristics, and  they  are  the  direct  result  of  the  internal  secretion 
of  the  sexual  glands.  They  only  develop  through  the  presence  of 
such  a  secretion,  and  this  is  easily  demonstrated  by  the  fact  that 
after  castration  of  the  infant,  they  do  not  appear  at  all.  Hence, 
if  we  see  grown  up  men  with  no  trace  of  a  moustache  it  may 
indicate  an  undeveloped  condition  of  the  testicles.  Again,  we 
castrate  a  young  cock,  he  will  not  grow  a  comb  and  spurs,  and 
other  cocks  will  pass  by,  too  proud  to  fight  with  a  degenerate 
deprived  of  its  male  attributes.  If  we  now  take  the  extirpated 
testicle  of  such  cock  and  graft  it  under  his  skin,  the  other  cocks 
will  commence  to  fight  with  him,  for  his  comb  and  spurs  will 
develop  as  in  other  normal  cocks. 

That  the  whole  external  appearance  of  a  castrated  animal 
or  man  is  changed,  is  also  demonstrated  by  important  changes 
in  the  skeleton  and  size  of  such  animals  or  persons. 

As  Poncet1  has  shown,  the  extremities  of  a  castrated  rabbit 
become  abnormally  long,  and  it  is  a  well-known  fact  that 
eunuchs  have  abnormally  long  arms  and  legs.  This  also  occurs 
in  cases  of  infantilism,  which,  as  we  know,  is  due  to  a  non-devel- 
opment of  the  sexual  glands.  Moreover,  the  thyroid  of  such 
individuals  is  also  found  to  be  in  a  pathological  condition,  as 
was  shown  by  Hertoghe. 

Men  who  have  been  castrated  before  puberty  or  whose  tes- 
ticles are  undeveloped,  present  such  an  external  appearance.  They 
have  no  moustache,  as  above  mentioned;  their  hair  is  dry  and 
brittle  and  remains  short ;  their  faces  are  pale,  and  of  a  yellowish 
hue;  their  hands  are  cold  and  reddish  blue.  Often  the  skin  of 
the  face  is  like  parchment  and  has  many  wrinkles.     Their  intelli- 


1  Poncet:     C.  R.  de  la  Societe  de  biologie  de  Paris,  55. 


External  Appearance  and  Nutrition  of  Tissues.  13 

gence  is  often  diminished,  as  we  will  show  later  oil,  and  they  arc 
usually  anaemic. 

Women  with  undeveloped  ovaries  have  flat  breasts  and  hips*, 
their  faces  are  often  irregular  in  structure,  and  their  jaws  are 
often  prominent ;  their  gums  are  shrunken  and  their  teeth  are 
long  and  soon  fall  out.  Some  cases  may  show  a  colossal  obesity, 
but  in  the  partial  forms  of  ovarian  insufficiency  they  may  be 
remarkably  thin.    They  also  are,  as  a  rule,  anaemic  or  chlorotic. 

In  some  parts  of  the  Orient,  as  in  India,  there  are  female 
eunuchs,  such  as  Roberts  has  seen  on  the  way  from  Delhi  to  Bom- 
bay. Such  eunuchs  had  no  bosom  ;  the  pubic  hair  was  absent,  and 
their  buttocks  were  like  those  of  men;  but  the  rest  of  the  body 
was  stouter.  Of  course  these  women  had  been  castrated  during 
their  childhood. 

If  we  make  a  Roentgen-ray  examination  of  the  skeleton  of  a 
person  castrated  in  childhood,  we  shall  find  that  the  epiphysial  car- 
tilages remain  unossified  for  a  long  time  after  puberty. 

It  is  a  very  interesting  fact  that,  both  after  castration  and 
in  myxoedema,  the  same  persistence  of  the  epiphysial  cartilages 
and  retardation  of  ossification  have  been  observed  by  means  of 
the  Roentgen-rays:  by  Hertoghe  in  1896;  Springer  and  Ser- 
banesco  in  1897;  Gasne  and  Laude  in  1898;  Legry  and  Renault 
in  1902;  Jeandelize  in  1903.  The  same  thing  has  also  been 
observed  by  Hertoghe  in  "Infantilism  of  the  Type  of  Lorraine." 

The  influence  of  the  thyroid  upon  the  skeleton  and  size  of 
the  body  is  easily  shown  by  simple  observations. 

Children  of  parents  with  cachectic  diseases  like  chronic  tuber- 
culosis, syphilis,  alcoholism,  etc.,  in  which  the  thyroid  gland  is, 
as  a  rule,  found  degenerated  (Gamier,2  Hertoghe3),  are  (as 
shown  by  Prof.  Perrando4  and  Gamier)  born  with  a  congenital 
atrophy  of  the  thyroid.     Just  as  young  animals  with  an  extir- 


2  Gamier :     "La  Thyroide  dans  les  maladies  infectieuses,"  These  de  Paris, 
1899. 

3 Hertoghe:     Loc.  cit. 

4Perrando:     "Sulla  struttura  della  Tiroide,"  Sassari,  1900. 


14  Old  Age  Deferred. 


pated  thyroid,  so  these  children  will  not  grow,  and  we  know 
that  cretins  (degeneration  of  the  thyroid)  remain  as  a  rule  dwarfs 
all  their  life  long.  We  can  now  produce  in  such  persons  certain 
and  very  curious  changes  by  feeding  them  with  thyroid  extract, 
and  we  can  see  them,  as  Hertoghe  has  shown,  grow  inch  by  inch 
in  a  short  period ;  their  mental  faculties  improving  at  the  same 
time  in  an  incredible  manner. 

The  influence  of  the  thyroid  upon  the  skeleton  is  also  shown 
by  the  fact,  established  by  Gauthier,5  that  in  a  fracture  with  but 
little  tendency  to  the  formation  of  a  callus,  union  takes  place 
much  more  quickly  after  administration  of  thyroid  extract. 

In  Graves's  disease,  with  exaggeration  of  the  thyroid  activ- 
ity, there  is,  on  the  other  hand,  an  increased  elimination  of  the 
most  important  constituent  of  the  skeletal  tissues :  calcium  car- 
bonate, and  this  occurs  also  in  acromegaly  and  diabetes,  in  which 
conditions  the  thyroid  is  very  frequently  altered  (Lorand6). 

Osteomalacia,  which  is  associated  with  an  enormous  elimi- 
nation of  calcium  carbonate  is,  as  we  at  present  consider,  due  to 
an  exaggerated  ovarian  activity  (Fehling),  and  can  be  favor- 
ably influenced  by  castration  or,  by  what  would  be  more  reason- 
able, thyroid  treatment. 

No  less  powerful  than  that  of  the  thyroid  is  the  influence 
of  the  pituitary  body  upon  the  skeleton,  especially  upon  the 
hands,  feet,  and  skull.  And  if  we  wish  to  demonstrate  how  much 
the  ductless  glands  influence  the  looks  of  a  person,  it  is  suffi- 
cient to  point  out  the  great  changes  that  take  place  in  the  face 
of  a  patient  with  acromegaly.  This  disease  makes  such  persons 
look  very  much  as  "Punch"  is  depicted. 

The  skin  and  complexion  of  persons  suffering  from  changes 
in  the  ductless  glands  are  also  very  different  from  normal.  Thus 
Addison's  disease,  due,  as  well  known,  to  a  degeneration  of  the 
adrenals,  makes  a  white  man  look  more  or  less  like  an  Indian, 
and  there  is  a  pigmented  skin  also  in  persons  affected  by  the 


5  Les  Medications  thyroidiennes,   1902. 

6  Lorand :     Loc.  cit. 


External  Appearance  and  Nutrition  of  Tissues.  15 

partial  form  of  that  rare  disease.  We  can  also  easily  show  that 
changes  in  the  thyroid  are  followed  by  changes  in  the  condition 
of  the  skin.  Thus,  with  thyroid  degenerations,  as  in  myxoedema, 
the  skin  is  pale  with  a  yellowish  tinge.  In  Graves's  disease  pig- 
mentation of  the  skin  can  often  be  observed,  and  not  rarely 
cutaneous  eruptions. 

In  affections  of  the  sexual  organs  in  woman  similar  condi- 
tions of  the  skin  can  occur.  Such  persons  often  present  wrinkles 
at  a  very  early  age,  and  certainly  look  older  than  their  years. 
Infants  suffering  from  congenital  degeneration  of  the  thyroid 
gland  often  look  withered  and  present  a  face  as  wrinkled  as  a 
sexagenarian.  We  see  this  also  in  congenital  syphilis  (atrophy 
of  the  thyroid). 

The  hair  also  very  often  shows  alterations  in  diseases  of 
the  thyroid,  or  ovaries.  Thus,  in  myxcedema  there  is  an  atrophy 
of  the  follicles  of  the  hair,  which  falls  out,  even  in  the  case  of 
the  eyebrows. 

It  is  particularly  interesting  that,  by  thyroid  medication,  a 
new  growth  of  hair  has  been  observed  in  places  where  it  had 
fallen  out  years  previously,  as  we  have  observed,  with  other 
authors,  in  several  cases  after  thyroid  medication.  And,  very 
strange  to  say,  this  newly-grown  hair  was  quite  dark  while  the 
hair  that  had  previously  been  in  its  place  was  gray  in  color. 
It  has  been  authentically  stated  by  several  authorities  that  old 
persons  of  sixty  or  seventy  have  acquired  black  hair  under  thy- 
roid treatment. 

On  the  other  hand,  in  much  younger  persons,  perhaps  under 
thirty,  who  are  suffering  from  complete  or  partial  degeneration 
of  the  thyroid  gland,  the  hair  very  often  turns  gray ;  so  much  so 
that  Hertoghe  considers  this  to  be  one  of  the  typical  symptoms 
of  such  a  condition. 

The  falling  out  of  hair,  or  its  turning  gray,  after  acute 
infectious  diseases  or  after  grief  and  sorrow,  may  have  some 
connection  with  the  well-known  changes  in  the  ductless  glands, 
especially  in  the  thyroid,  in  these  conditions.     This  is  made  quite 


16  Old  Age  Deferred. 


clear  by  Sajous's  demonstration  that  these  glands  collectively 
govern  the  activity  of  general  oxidation,  that  is  to  say  the  vital 
process  itself. 

As  we  have  previously  mentioned,  a  moustache  or  whiskers 
may  grow  in  women  suffering  from  disease  of  the  ovaries,  just 
as  after  castration  or  the  climacteric.  It  is  also  very  interesting 
that  a  premature  grayness  often  occurs  in  cases  of  insanity,  and 
can  be  attributed  to  the  frequent  changes  in  the  thyroid  and 
sexual  glands  in  these  conditions. 

The  nutrition  of  the  skin  is  entirely  under  the  influence  of 
the  thyroid.  After  extirpation  or  degeneration  of  the  thyroid, 
there  occurs  atrophy  of  the  sebaceous  and  sudorific  glands. 

In  myxcedema  the  skin  is  dry  and  never  perspires.  On  the 
contrary,  in  Graves's  disease,  or  after  thyroid  medication  in 
large  doses,  there  is  abundant  perspiration. 

Deposits  of  tartar  are  common  symptoms  in  all  forms  of 
thyroid  degeneration.  Retraction  of  the  gum  follows  and  the 
teeth  loosen  and  fall  out.  This  is  also  a  common  symptom  in 
diabetes,  but  here  only  in  advanced  cases.  In  such  cases  there 
is,  as  we6a  have  shown,  an  exhaustion  of  the  thyroid  gland,  which 
develops  as  a  consequence  of  the  previous  hyperactivity  of  the 
thyroid  gland  in  the  early  stages  of  the  disease.  As  a  rule  the 
teeth  of  a  diabetic  only  fall  out  in  the  severer  form  of  the  disease, 
generally  after  acetone  has  begun  to  show  itself  in  the  urine. 

Important  changes  take  place  in  the  subcutaneous  tissue 
after  extirpation  of  the  thyroid  gland.  In  such  cases  there  is 
either  augmentation  of  connective  tissue  or  of  fat.  Thus,  in 
the  case  of  a  young  bull,  whose  history  we  followed,  there  has 
been  an  increase  of  thirty  pounds  of  fat  within  a  few  months 
after  extirpation  of  the  thyroid.  The  same  thing  happened  in  the 
case  of  a  young  horse,  whose  thyroid  was  also  extirpated. 

There  are,  however,  still  more  facts  which  show  the  great 
influence  of  the  thyroid  upon  the  metabolism  of  fat.     Thus  we 


6aLorand:     "Die  Entstehung  der  Zuckerkrankheit,"  Berlin,  1903,  and  in 
French  translation,  Paris,  1904. 


External  Appearance  and  Nutrition  of  Tissues.  17 

know  very  well  that  by  thyroid  medication  we  are  able  to  reduce 
fat  considerably.  This  is  due  to  the  action  of  the  thyroid  which, 
as  shown  by  many  authors,  increases  the  process  of  oxidation. 
In  Graves's  disease  these  processes  are  augmented.  In  the  oppo- 
site condition  (myxcedema)  they  are  diminished.  By  giving 
thyroid  extract  we  are  able  to  augment,  positively,  the  processes 
of  oxidation  in  the  tissues,  as  shown  by  Professor  Magnus-Levy,7 
of  Berlin,  and  many  others. 

As  we  have  shown  in  our  previous  researches,  there  is  an 
abundant  formation  of  fat  in  the  early  cases  of  degeneration  of 
the  thyroid  gland,  which  sometimes  progresses  to  a  colossal 
obesity,  which  obesity  has  nothing  to  do  with  overfeeding. 
Such  individuals  have,  as  a  rule,  but  poor  appetites,  and  eat 
very  little.  Therefore,  in  a  communication  to  the  French  Con- 
gress of  Internal  Medicine  in  Paris,  1904,  we  differentiated 
two  kinds  of  obesity:  1.  Exogenous  obesity — i.e.,  arising  by 
agencies  coming  from  without  by  the  food  we  introduce  into 
our  body.  2.  Endogenous  obesity,  having  its  origin  within  our 
economy,  and  depending  on  changes  in  certain  glands  which 
govern  the  processes  of  oxidation — e.g.,  thyroid  sexual  glands, 
pituitary  body.  This  second  form  is  independent  of  our  feeding. 
As  we  have  shown,  this  latter  can  be  produced  by  any  of  those 
agencies  which  are  harmful  to  the  ductless  glands,  especially  the 
thyroid  and  sexual  glands,  as,  for  example,  infectious  diseases, 
frequent  pregnancies,  certain  toxic  products  (alcohol),  sexual 
excesses,  climateric.  All  these  conditions  may  have  the  effect 
of  producing  obesity,  which  can  be  explained  by  an  exhaustion 
of  the  thyroid  and  ovaries  following  a  pre-existing  hyperac- 
tivity. 

The  influence  of  the  ovaries  upon  the  production  of  obesity 
can  be  demonstrated  by  the  sequels  of  castration,  and  also  by 
the  fact  that  women,  after  one  or  more,  especially  several  preg- 


7  Magnus-L6vy :  "Der  Stoffwechsel  bei  Erkrankungen  einiger  Drusen  ohne 
Ausfiihrgang,"  in  v.  Noorden's  "Handbuch  der  Pathologie  des  Stoffwechsels" 
vol.  ii,  Berlin,  1907. 

2 


18  Old  Age  Deferred. 


nancies,  or  after  sexual  excesses,  may  become  very  fat.  In  such 
women  this  obesity  may  be  only  partial  and  limited  (as  we  have 
shown  in  a  recent  communication  to  the  International  Congress 
of  Medicine  in  Lisbon,  1906)  to  certain  parts — e.g.,  the  mam- 
mary glands  or  hips. 

There  can  be  no  doubt  that  the  sexual  glands  influence  the 
nutrition  of  the  tissues  in  a  powerful  manner,  and  this  has  also 
been  shown,  experimentally,  by  the  researches  of  two  Berlin 
experimenters,  Professors  Loewy  and  P.  I.  Richter,8  performed 
in  the  physiological  institution  of  Professor  Zunz.  These  savants 
have  shown  that  after  castration  there  is  a  diminution  of  oxida- 
tion. By  giving  extracts  of  dogs'  testicles  to  castrated  male 
dogs,  they  were  able  to  augment  the  processes  of  oxidation. 
These  processes,  however,  were  still  more  increased  after  the 
administration  of  female  extracts  to  these  castrated  male  dogs. 
The  administration  of  ovarian  extracts  to  the  spayed  bitch  has, 
of  course,  given  still  better  results.  Thus  there  was  here  an 
increase  of  67.7  per  cent,  after  castration,  and  37.6  per  cent,  of 
the  original  value.  The  increase  of  the  oxidation  in  male  dogs 
was  44.5  per  cent,  after  castration,  by  the  treatment  with  ovarian 
extracts,  and  24.8  per  cent,  above  the  normal  value.  If  the 
results  after  feeding  with  male  extracts  were  not  so  successful, 
it  must  be  attributed  to  the  circumstance  that  we  are  at  present 
unable  to  produce  testicular  extracts  of  the  same  efficacy  as 
ovarian  extracts. 

The  action  of  the  pituitary  body  upon  metabolism  has  been 
shown  by  Narbuth,  who  found  a  diminution  of  oxidation  after 
degeneration  of  the  pituitary  body,  and  an  increase  after  medi- 
cation with  extracts  of  the  same  organ.  This  fact  is  also  shown 
clinically  by  cases  of  obesity  after  degeneration  of  the  pituitary 
body  in  acromegaly,  and  by  the  interesting  fact  (shown  by  a 
great  number  of  authorities  and  recently  by  Frohlich,9  Berger,10 

8  Loewy  and  Richter:  Archiv  fiir  Anat.  u.  Physiologie,  Supplement,  1899, 
and  Berliner  klin.  Wochenschrift,  1899. 

9  Wiener  klin.  Rundschau,  p.  78,  1901. 
10  Zeitschrift  fur  klin.  Med.,  liv,  p.  5,  6. 


External  Appearance  and  Nutrition  of  Tissues.  19 

and  Erdheim11)  that  cases  of  pituitary  tumor  may  be  met  with, 
associated  with  obesity,  and  without  any  of  the  symptoms  of 
acromegaly.  Especially  interesting  is  the  case  of  Madelung12 
showing  a  colossal  obesity  in  a  girl  aged  9  years,  after  a  gun- 
shot injury  of  the  pituitary  body.  This  observation  sustains,  and 
is  clearly  explained  by,  Sajous13  who  showed  that  the  posterior 
or  neural  lobe  of  the  pituitary  body  contained  a  nerve  center 
which  governed  the  functional  activity  of  the  thyroid,  and  that 
the  secretion  of  the  latter  insured  the  catabolism  of  fats  by  in- 
creasing their  vulnerability  to  oxidation. 

The  external  appearance  of  such  cases  of  obesity,  which  we 
have  described  before  the  French  Congress  of  Medicine  in  1904, 
and  the  London  Pathological  Society,  February  21,  1905,  as 
endogenous  obesity,  is  also  clinically  different  from  the  appear- 
ance of  those  caused  by  over-feeding.  As  we  have  shown,  per- 
sons addicted  to  rich  food,  with  little  exercise,  are  often  red  in 
the  face,  and  are  plethoric;  they  easily  become  overheated  and 
perspire  freely.  They  seldom  complain  of  constipation.  On  the 
other  hand  persons  suffering  from  endogenous  obesity  generally 
look  pale,  always  complain  of  cold  and  dry  skin,  and  perspire 
very  seldom,  if  at  all.     As  a  rule  they  are  also  very  constipated. 

There  is  still  another  ductless  gland  which  influences  metab- 
olism in  a  powerful  way.  This  is  the  pancreas  which,  by  its 
three  enzymes,  brings  about  the  assimilation  of  the  proteid  car- 
bohydrate and  fatty  materials.  To  these  may  also  be  added  its 
production  of  labferment.  By  its  internal  secretion,  which  is 
probably  produced  by  the  islands  of  Langerhans,  it  aids  in  the 
oxidation  of  the  sugar,  introduced  into  our  alimentary  canal  in 
the  shape  of  starchy  food,  or  contained  in  the  carbohydrated 
radicle  of  the  albuminous  molecules,  as  demonstrated  by  Pavy. 
The  entire  degeneration  of  the  pancreas,  especially  of  the  part 
containing  the  islands  of  Langerhans,  produces  a  disease  that  is, 


11  Ziegler's  Beitrage,  1903. 

l2Archiv  fur  klin.  Chirurgie,  p.  1066,  1904. 

13  Sajous:     "Internal  Secretions,  etc.,"  vol.  ii,  1907. 


20  Old  Age  Deferred. 


as  a  rule,  characterized  by  loss  of  weight  and  the  production  of 
emaciation  often  to  an  astonishing  degree — i.e.,  diabetes. 

Persons  suffering  from  the  milder  form  of  this  disease  often 
present  a  rosy  and  healthy  appearance,  and  as  we  have  pointed 
out  previously,  often  look  younger  than  their  age.  We  believe 
that,  as  we  shall  show  further  on,  this  fact  is  not  without  rela- 
tion to  the  condition  of  the  thyroid  in  this  disease.  We  have 
shown  by  researches  made  in  the  laboratory  of  Professor  Min- 
kowski, then  of  the  Augusta  Hospital  in  Cologne,  that  in  diabetes 
the  thyroid  contains  large,  sometimes  enormous,  quantities  of 
colloid  substance,  thus  indicating  a  condition  of  thyroid  hyper- 
activity. 

As  we  have  mentioned  in  the  first  chapter,  corpulence  is 
often  one  of  the  first  symptoms  of  old  age,  and  we  have  also 
insisted  upon  the  fact  that  this  can  be  brought  about  by  infec- 
tious diseases  {e.g.,  typhoid,  pneumonia,  scarlet  fever,  etc.).  As 
we  have  also  mentioned  the  fact,  in  the  first  chapter,  that  old 
age  can  be  brought  about  by  an  infectious  disease  which  acts 
upon  the  ductless  glands,  especially  the  thyroid,  we  believe  it  will 
be  necessary  to  enter  a  little  more  in  detail  into  this  subject,  to 
which  we  will  devote  the  next  chapter.  We  will  enlarge  upon 
the  fact  that  our  immunity  against  infectious  diseases  is  entirely 
dependent  on  the  proper  working  order  of  certain  ductless 
glands. 


CHAPTER   III. 

On  the  Agencies  which  Govern  Immunity  Against 
Infections  and  Intoxications — The  Origin  of  Fever. 

From  the  moment  of  our  birth  we  are  constantly  exposed 
to  the  incessant  attacks  of  innumerable  bacteria  and  to  the  effects 
of  a  large  amount  of  poisonous  material  formed  within  our  body 
or  introduced  from  without,  and  if  we  survive  tlrs  ceaseless 
battle  it  is  due  to  the  powerful  weapon  we  possess  in  the  internal 
secretion  of  the  ductless  glands,  especially  of  the  thyroid  gland. 
That  this  gland  possesses  very  energetic  antitoxic  properties  can 
be  shown  by  the  fact  that  when  it  is  extirpated  animals  or  per- 
sons very  readily  acquire  infectious  diseases  of  all  sorts.  Thus, 
the  late  Professor  Charrin,1  of  Paris,  showed  several  years  ago 
how  readily  dogs  that  have  lost  their  thyroid  succumb  to  all 
possible  infections.  Professor  W.  S.  Greenfield,2  of  Edinburgh, 
has  found  that  persons  suffering  from  myxcedema  (athyroidia) 
very  often  die  from  tuberculosis,  and  Professor  Pel,3  of  Amster- 
dam, found  a  great  frequency  of  tuberculosis  in  the  families  of 
myxedematous  persons.  This  coincides  with  the  conclusions 
of  Prof.  G.  R.  Murray,4  Professor  Lanz,  and  ourself,  that  the 
properties  of  the  thyroid  can  be  inherited.  Sajous  has  shown, 
moreover,  that  the  pituitary,  the  adrenals  and  the  thyroid  con- 
stituted the  autoprotective  mechanism  of  the  body  against  disease, 
a  fact  not  only  sustained  by  the  above  evidence,  but  also  by  a  vast 
number  of  additional  facts. 

As  we  showed  at  the  last  Congress  of  Tuberculosis  in  Paris, 


1  Charrin:    "Les  Defenses  naturelles  de  Porganisme,"  Paris,  1898  (Masson). 

2  Greenfield :     Quoted  after  Ewald,  "Die  Erkrankungen  der  Schilddriise," 
Nothnagel's  Handbuch.  Wien.  p.  159,  1896. 

3  Pel:     "Myxcedema,"  Volkmann's  Sammlung  klin.  Vortrage,  1895,  No.  123. 
4 Murray:     "Diseases  of  the  Thyroid  Gland,"  Part  i,  London,  1901. 

(21) 


22  Old  Age  Deferred. 


1905,  tuberculosis  is  especially  frequent  as  a  sequel  to  any  process 
deleterious  to  the  thyroid  gland,  as  after  the  puerperium,  espe- 
cially with  prolongated  lactation ;  after  sexual  excesses,  as  there 
is  a  relation  between  the  sexual  glands  and  the  thyroid:  after 
various  infectious  diseases ;  after  rapid  growth  in  puberty,  due 
to  hyperactivity  of  the  thyroid  which  influences  the  growth  of 
the  body ;  after  severe  diabetes  due  to  exhaustion  of  the  thyroid ; 
and  after  previous  hyperactivity  in  chronic  alcoholism  due  to 
the  action  of  alcohol  upon  the  thyroid.  On  the  other  hand,  all 
those  agencies  which  excite  thyroid  activity  may  be  a  preventive 
against  tuberculosis,  such  as  raw  meat  and  milk.  It  has  been 
shown  that  milk  contains  the  internal  secretion  of  the  thyroid. 

The  thyroid  protects  us  against  poisons  of  different  origin, 
such  as  the  products  of  decomposition  of  protein  food.  This 
fact  is  shown  by  the  experiments  of  Dr.  Leo  Breisacher,  of 
Detroit,5  formerly  assistant  of  the  late  Professor  Munk,  of  Ber- 
lin, and  from  those  of  Dr.  Blum,6  of  Frankfort.  The  experi- 
mental results  of  Dr.  Chalmers  Watson,"  showing  alteration 
of  the  thyroid  in  certain  animals  after  an  exclusive  diet  of  raw 
meat,  and  those  of  Dr.  D.  Forsyth8  concerning  the  pituitary 
body  in  some  animals,  may  be  correlated  with  this  fact.  As 
is  well  known,  the  thyroid  and  pituitary  body  stand  in  very  close 
relationship.  Galeotti  and  Lindemann,9  in  1897,  have  also  shown 
that  the  products  of  decomposition  of  meat  produce  an  increase 
of  the  colloid  substance  of  the  thyroid. 

The  antitoxic  properties  of  the  thyroid  against  different 
products  is  also  shown  by  the  observations  of  Lanz10  and  Walter 
Edmunds,11  who  have  found  that  animals  without  thyroid  re:-: 5: 

5  Breisacher :  "Untersuehung  fiber  die  Gland  Thyroidea,"  Archiv  fur 
Anatomie  und  Physiologie,  SuppL,  Bd.,  p.  509,  1889. 

6  Blum :  Pflfiger  3  Archiv,  vol.  xc,  p.  285,  1902 ;  Archiv  fur  die  Gesammte 
Physiologie,  p.  617,  1902. 

7  Chalmers  Watson:     The  Lancet,  p.  347,  Feb.  11,  1905. 
s  Forsyth:     The  Lancet,  p.  154,  Jan.  19.  1907. 

9  Lindemann:     Yirehovr's  Archiv,  p.  202.  1897. 
10  Lanz:     Zur  Sehilddrfisenfrage,  Leipzig.  1S94. 

ii  W.  Edmunds:     The  Lancet,  May  11th.  p.  1317;    13th,  p.  1381;     .'- ':.. 
p.  1449,  1901. 


Immunity  Against  Infections  and  Intoxications.  23 

narcosis  badly;  and,  as  we  have  shown  in  a  communication  to 
the  Paris  Biological  Society,12  chloroform,  like  alcohol,  produces 
a  condition  of  hyperactivity  in  the  thyroid  gland,  which  results 
also  in  an  excited  mental  condition.  The  observation  that  cases 
of  Graves's  disease  and  of  severe  diabetes  cannot  stand  narcosis 
may  be  related  to  this  fact. 

It  has  been  shown  recently  by  Hunt13  that  the  thyroid  pro- 
tects us  against  poisons  like  acetonitril,  and  that  iodine  acts 
through  the  thyroid.  Gamier,14  of  Paris,  has  found  that  cer- 
tain chemical  products,  such  as  iodine,  produce  great  alterations 
in  the  thyroid.  As  is  well  known,  cases  of  Graves's  disease 
(hyperthyroidia)  have  been  observed  after  iodine  treatment. 
That  the  thyroid  fulfils  a  protective  role  against  infectious  dis- 
eases may  already  be  considered  proved  by  the  fact  that, 
as  Roger  and  Gamier,15  Crispin,16  Torre,17  Bayon,18  of  Wiirz- 
burg;  de  Quervain,  and  others  have  found,  the  thyroid  is,  as  a 
rule,  altered  in  infectious  diseases.  As  Roger  and  Gamier  have 
shown  by  a  series  of  investigations  confirmed  by  the  above- 
named  authors,  the  thyroid  shows  in  acute  infectious  diseases 
with  fever  an  increased  activity  with  enlargement  of  the  follicles, 
which  are  filled  with  a  large  quantity  of  colloid  substance  which 
may  even  enter  into  the  adjacent  lymphatic  spaces.  However, 
this  hyperactivity  of  the  thyroid  gland  may  be  followed  by  its 
exhaustion,  and  thus  after  a  certain  duration  of  high  fever  there 
may  be  no  colloid  substance  at  all  in  the  folliculi. 

It  is  only  logical  to  suppose  that  with  anatomo-pathological 
alterations  of  the  thyroid,  indicating  a  condition  of  hyperactivity, 
there  must  be  corresponding  clinical  symptoms  and  that  these 


l^Lorand:     G.  R.  de  la  Societe  de  biologie,  1906. 

13  Hunt:     International  Congress  of  Physiology,  Heidelberg,  1907. 

14  Gamier :     "La  Thyroide  dans  les  maladies  infectieuses,"  These  de  Paris, 
1899. 

15  Roger  et  Gamier:     Presse  medicale,  April  19,  1899. 

16  Crespin :     Giornale  dell'  Assoeiazione  Napolitano  di  Medici,  xii,  3. 

17  Torre:     "La  Tiroide  nei  Morbi  Infettivi,"  II  Policlinico,  No.  6,  p.  145; 
No.  8,  p.  226;    No.  10,  p.  280. 

18  Bayon;     Wiirzburger  Abhandlungen,  1904. 


24  Old  Age  Deferred. 


must  necessarily  be  similar  to  those  found  in  another  condition 
of  hyperactivity  of  the  thyroid  gland — i.e.,  in  Graves's  disease, 
the  condition  of  hyperthyroidia.  And,  indeed,  such  must  be  the 
case,  for,  as  we  shall  try  to  show,  fever  and  Graves's  disease  have 
similar  clinical  symptoms.  Thus  their  most  typical  symptom 
is  the  same :  tachycardia  or  increased  frequency  of  the  pulse, 
without  which  no  case  of  Graves's  disease  should  be  diagnosed. 
There  is  a  sensation  of  heat  in  most  of  the  cases  of  Graves's 
disease,  and  the  temperature  sometimes  reaches  a  dangerous 
degree  in  fully  developed  cases  of  this  disorder.  Thirst,  fre- 
quent in  fever,  is  also  a  frequent  symptom  in  Graves's  disease 
(polydipsia  in  14  out  of  59  cases  recorded  by  Albert  Kocher19), 
and  can  also  be  produced  by  thyroid  feeding  (Lanz,20  Georgiew- 
ski,21  and  others).  After  a  certain  duration  of  fever  further 
symptoms  of  an  increased  activity  of  the  thyroid  appear,  such 
as  abundant  perspiration — a  typical  feature  of  Graves's  disease. 
Vaso-dilatation  and  excessive  perspiration  can  also  be  produced 
by  thyroid  feeding.  The  latter  symptom  of  fever  is  a  device 
by  which  nature  tries  to  eliminate  toxic  products,  and  accordingly 
there  generally  follows  upon  it  a  fall  in  the  temperature  and  an 
amelioration  of  the  symptoms  of  fever.  The  diarrhoea  which 
we  find  in  some  infectious  diseases,  like  that  of  typhoid  fever, 
trypanosomiasis,  etc.,  is  also  a  typical  symptom  in  Graves's  dis- 
ease. When  the  fever  subsides  there  appears  another  typical 
symptom  of  this  condition :  polyuria.  To  complete  this  analogy 
we  may  mention  toxic  decomposition  of  proteins,  diminution  in 
the  body  weight,  great  muscular  weakness,  and  increased  elimi- 
nation of  urea  and  uric  acid  as  typical  symptoms  of  both  condi- 
tions. As  in  Graves's  disease,  there  is  also  in  fever  an  aug- 
mentation of  the  processes  of  oxidation.  Glycosuria  is  frequent 
in  both  conditions,  and  acetonuria  may  occur  in  fever  and  also 


19 A.  Kocher:     "Mittheilungen  aus  den  Grenzgebeiten,"  etc.,  1901. 

20  Lanz:     Quoted  after  Buschau,  Wein,  1895. 

21  Georgiewski :     Zeitschrift  fur  klin.  Medicin,  Bd.,  xxxiii,  f .  1-2,  p.  153, 
1897. 


Immunity  Against  Infections  and  Intoxications.  25 

in  Graves's  disease.  Glycosuria  and  diabetes  in  consequence  of 
infectious  diseases  are,  as  we  have  shown  in  a  paper  read  before 
the  London  Pathological  Society,22  probably  due  to  the  increased 
activity  of  the  thyroid,  and  their  disappearance,  occasionally 
after  a  high  fever,  may  be  ascribed  to  the  exhaustion  of  the  thy- 
roid after  a  previous  hyperactivity.  We  know  that  a  condition 
of  Graves's  disease  may  be  followed  by  a  myxoedematous  condi- 
tion in  which,  as  we  have  shown  previously,  glycosuria  is  very 
rare.  In  the  few  hitherto  published  cases  there  was  no  com- 
plete myxcedema. 

Both  in  Graves's  disease  and  fever  there  is  an  augmentation 
of  the  processes  of  oxidation.  After  convalescence,  however, 
oxidation  may  be  diminished,  and  this  explains,  as  we  have  shown 
at  the  French  Congress  of  Medicine  in  1904,23  why  obesity  so 
frequently  occurs  after  infectious  diseases  on  the  basis  of  degen- 
erative changes  of  the  thyroid,  which  governs  oxidation ;  during 
the  course  of  infectious  disease  with  fever  increased  activity  of 
the  thyroid  and  loss  of  weight  occur,  and  these  are  followed  by 
exhaustion  of  thyroid  activity  and  obesity. 

The  conditions  of  delirium  and  maniacal  exaltation  in  cases 
of  high  fever  are  analogous  to  the  condition  of  mental  exalta- 
tion that  may  occur  in  Graves's  disease.  According  to  the  late 
Moebius,24  in  cases  of  Graves's  disease  there  are  sometimes 
symptoms  like  those  of  alcoholic  intoxication  due  to  the  toxins  of 
the  thyroid.  We  believe  that  the  mental  exaltation  in  chloroform 
narcosis  and  alcoholic  intoxication  stands  in  relation  with  the 
action  of  these  drugs  upon  the  thyroid.  That  alcohol  acts  upon 
the  thyroid  has  been  shown  by  de  Quervain,  Hertoghe,25  and 
others.     Sajous  in  his  work  on  the  "Internal  Secretions,"  urges 


22  Lorand :     Transactions  of  the  Pathological  Society  of  London,  vol.  lvii, 
part  1,  1906. 

23  Lorand:     Congres  Franeais  de  Mgdecine,  Paris,  1904. 

24  Moebius :       "Die     Basedow'sche     Krankheit,"     NothnagePs     Handbuch, 
second  edition. 

25 Hertoghe:      "Die   Rolle   der    Schilddriise,"    etc.,    Munchen,    1900;     and 
"Paludisme  et  Myxoedeme,"  Progres  rnSdical  Beige,  No.  2,  1902. 


26  Old  Age  Deferred. 


that  the  thyroid  is  not  directly  excited  by  toxins  and  other  poisons 
which  produce  fever,  but  that  these  toxics  excite  primarily  the 
thyroid  center  (or  better  the  adreno-thyroid  center,  for  he  holds 
that  the  adrenals  are  also  governed  by  this  center)  thus  increas- 
ing the  secretory  activity  of  the  gland.  The  correctness  of  this 
view  is  proved  by  the  fact  that,  as  shown  by  Sawandowski,26  sec- 
tion of  the  basal  tissues,  and,  therefore,  between  the  pituitary  and 
the  bulb,  prevented  the  production  of  fever,  due  to  putrid  mate- 
rials, and  also  the  influence  of  antipyretics,  antipyrin,  for  instance. 

Cutaneous  eruptions  may  occur  in  fever  or  in  Graves's  dis- 
ease. In  the  same  way  as  in  many  skin  diseases  they  may  be 
considered  as  the  expression  of  an  elimination  of  toxic  products 
through  the  skin. 

All  the  above  symptoms  of  fever  may  be  considered  as 
expression  of  the  efforts  of  nature  to  defend  herself  by  elimi- 
nating toxic  products.  All  toxic  products  which  are  the  causes 
of  infection  act  upon  the  thyroid  gland,  this  organ,  through 
increased  activity,  produces  symptoms  such  as  we  see  in  Graves's 
disease.  That  these  symptoms,  especially  abundant  perspiration, 
polyuria,  and  diarrhoea,  typical  in  some  infectious  diseases,  may 
be  considered  as  the  direct  consequence  of  thyroid  activity,  can 
best  be  shown  by  the  fact  that  the  thyroid  gland  governs  the 
functions  of  the  skin,  intestines,  and  kidneys. 

That  the  symptoms  of  fever  may  be  considered  as  due  to 
increased  thyroid  activity  is  also  shown  by  the  fact  that  nearly 
all  such  symptoms  may  be  produced  by  thyroid  preparations.  We 
have  personally  taken  for  experimental  purposes,  during  ten 
months,  thyroid  tablets  and  experienced  the  sensation  of  heat, 
flushings,  and  abundant  perspiration.  It  is  interesting  to  note 
that  all  kinds  of  wounds  and  contusions  we  got  during  the  time 
we  took  these  tablets,  healed  with  surprising  rapidity  with  fine 
granulations  far  better  than  previously;  on  the  other  hand,  we 
very  frequently  suffered  from  tonsillitis  and  acne  eruptions. 


26  Sawandowski :      Centralbl.  f.  d.  med.  Wissensch.  B.  xxvi,  S.  145,  161, 
1889. 


Immunity  Against  Infections  and  Intoxications.  27 

Symptoms  similar  to  fever  have  also  been  produced  in 
animals  by  thyroid  feeding;  thus,  very  often  elevation  of  the 
frequency  of  the  pulse  from  ioo  to  140-160  beats  (Lanz),  and 
from  150  to  200  beats  (Georgiewski),  while  Ballet  and  Enri- 
quez27  produced  regular  fever  in  their  animals ;  Easterbrook28 
also  produced  "some  pyrexia"  in  his  animals  and  an  increase 
of  pulse-rate  of  about  40  a  minute.  As  Dr.  Tanberg,  former 
assistant  of  the  Physiological  Institute  in  Christiania,  told  us, 
he  has  produced  an  increase  of  the  temperature  of  two  and  a 
half  degrees  in  animals,  whose  thyroid  he  had  extirpated,  after 
giving  very  large  quantities  of  thyroid  gland. 

It  is  of  great  interest  to  the  question  at  issue  that  the  reme- 
dies which  we  employ  to  fight  fever  should  also  produce  symp- 
toms like  the  thyroid  does  when  it  is  in  increased  activity.  Thus 
salicylates  produce  a  vaso-dilatation  and  abundant  perspiration, 
and  afterward  diminution  of  the  temperature.  We  have,  ourself, 
taken  salicylates  or  acetonitril  preparation  and  felt  the  sensation 
of  heat  and  afterward  perspiration.  When  we  take  a  hot  air 
or  steam  bath  for  cold  or  gouty  pains  we  produce  first,  great 
heat,  tachycardia,  and  then  abundant  perspiration,  and  the  typical 
symptoms  of  fever  or  increased  thyroid  activity. 

We  know  that  certain  drugs,  as  found  by  Gamier,  have  an 
exciting  action  upon  the  thyroid,  such  as  iodine,  and  what  is 
especially  important,  pilocarpine.  The  great  sudorific  action  of 
this  drug  may  stand  in  some  relation  to  its  effect  upon  the  thy- 
roid. It  is  permissible  to  suppose  that  the  different  drugs  which 
antagonize  fever  do  so  by  acting  first  upon  the  thyroid  gland 
and  exciting  its  increased  activity  to  fight  infection.  But  if  we 
gave  too  much  of  these  we  might  exhaust  the  activity  of  the 
gland  in  the  same  way  as  Gamier  found  an  exhaustion  of  the  col- 
loid of  the  thyroid  after  too  much  iodine.  This  shows  that  we 
should  not  give  antipyretics  in  too  large  doses.  We  should 
excite  thyroid  activity  but  not  overdo  it. 


2T  Ballet  and  Enriquez:     Quoted  after  Bnschau. 

28  Easterbrook :     The  Lancet,  p.  546,  August  27,  1898. 


28  Old  Age  Deferred. 


That  the  thyroid  is  able  to  protect  us  against  infectious 
diseases  can  be  best  shown  by  the  fact  that  it  exercises  a  great 
influence  upon  phagocytosis.  According  to  the  findings  of 
Fassin,  the  alexins  disappear  from  the  blood  after  the  extirpation 
of  the  thyroid  gland ;  and,  according  to  Sir  Almroth  Wright,  the 
production  of  opsonins  is  dependent  upon  internal  secretions. 
Hence,  it  is  of  the  greatest  value  to  us  that  Stepanoff28a  and 
Marbe  have  proved  by  experiments  conducted  in  the  Pasteur  In- 
stitute of  Paris  that  the  opsonins  disappear  after  the  extirpation 
of  the  thyroid  gland  but  increase  after  thyroid  treatment,  these 
experiments  thus  proving  the  correctness  of  our  clinical  observa- 
tions on  the  role  of  the  thyroid  gland  as  an  organ  for  protection 
against  infections,  as  published  in  The  Lancet  two  and  one-half 
years  ago.  Sajous,  who  was  first  (1907)  to  point  out  that  the 
thyroid  secretion  was  the  agent  which  Wright  termed  "opsonin," 
is  also  shown  to  have  been  right  by  the  investigations  of  Fassin, 
StepanofI  and  Marbe,  thus  proving  further  the  intimate  relation- 
ship between  the  thyroid  and  our  immunizing  functions. 

Fever  can  be  produced  with  similar  symptoms  by  toxic 
products  of  different  origin,  as  from  small  elements  of  the  vege- 
table kingdom  like  bacteria,  certain  plants,  and  even  fruits,  as 
is  shown  by  the  urticaria  which  follows  in  some  persons  after 
eating  strawberries.  Certain  minute  elements  of  the  animal 
kingdom  have  a  similar  power,  such  as  protozoa  like  trypano- 
somes,  and  we  may  also  instance  certain  kinds  of  animal  food 
like  oysters  in  certain  persons,  the  poison  of  snakes,  and  cer- 
tain insects  like  tarantulas  and  scorpions;  also  certain  minerals 
like  arsenic  and  phosphorus  can  produce  fever.  Besides  these 
poisons  coming  from  without,  fever  with  similar  symptoms  can 
also  be  produced  by  poisons  formed  within  our  body  by  the 
hyperactivity  of  a  gland — the  thyroid.  When  so  many  different 
poisons  produce  the  same  result  it  lies  near  to  suppose  that 
they  do  this  by  means  of  the  same  agency,  which,  according  to 


2SaStepanoff:     Comptes  Rendus  de  la  S.  B.  de  Paris,  1908. 


Immunity  Against  Infections  and  Intoxications.  29 

the  aforesaid  observations,  is  very  probably  a  thyroid  hyper- 
activity. The  modus  operandi  of  all  these  agents  is  well  studied 
in  Sajous's  work,  to  which  the  reader  is  referred. 

As  is  well  known,  a  condition  of  hyperactivity  of  the  thy- 
roid may  be  followed  by  its  exhaustion,  and  thus  Graves's  dis- 
ease may  often  be  followed  by  myxoedema,  i.e.,  athyroidia.  In  the 
same  way  the  hyperactivity  of  the  thyroid  gland  in  infectious 
diseases  may  also  be  followed  by  its  exhaustion  and  a  myx- 
edematous condition.  Even  complete  myxoedema  most  fre- 
quently appears  after  a  previous  infectious  disease — a  fact  recog- 
nized by  the  earliest  English  authors  on  this  disease.  Accord- 
ingly, it  is  not  surprising  if  an  infectious  disease  like  trypanoso- 
miasis is  followed  by  a  condition  like  sleeping  sickness,  which, 
as  we  have  shown  at  the  German  Congress  for  Internal  Medicine 
in  1905,  presents  all  the  clinical  symptoms  of,  and  identical 
anatomico-pathological  alterations  of  the  central  nervous  sys- 
tem noted  in,  myxcedema.  On  the  other  hand,  trypanosomiasis 
presents  all  the  typical  symptoms  of  Graves's  disease.  In  syph- 
ilis also,  after  the  fever  with  eruptions  in  the  secondary  stage, 
in  which  we  not  infrequently  see,  especially  in  women,  a  swell- 
ing of  the  thyroid,  we  find  in  the  tertiary  stage  many  symptoms 
of  a  condition  of  myxcedema  or  hypothyroidia,  and  with  the 
iodine  treatment  we  add  to  the  blood  the  main  element  of  the 
thyroid  gland.  Iodine  is  also  especially  active,  if  not  given  in 
too  large  doses,  in  exciting  thyroid  activity,  and  sometimes  it 
even  provokes  Graves's  disease. 

Persons  of  healthy  constitution  with  a  good  working  thy- 
roid may  get  the  sensation  of  heat  and  perspiration  spontane- 
ously after  a  cold,  or  gouty  pains,  even  without  salicylates,  and 
feel  better  afterward,  whereas  persons  with  a  deficient  thyroid 
have  difficulty  in  producing  the  symptoms  of  fever.  Recently 
we  observed  a  young  man,  aged  22  years,  with  symptoms  of 
hypothyroidia  as  described  by  Hertoghe,  who  had  follicular 
tonsillitis.  He  presented  none  of  the  symptoms  of  fever,  but 
it  took  him  ten  days  to  get  over  it  and  he  felt  very  weak  after- 


30  Old  Age  Deferred. 


ward.  There  was  this  summer  an  epidemic  of  typhoid  fever  in 
the  lunatic  asylum  of  Colorno,  near  Pavia.  We  have  it  from  Dr. 
Gassenghi,  of  the  University  of  Pavia,  that  half  of  the  patients 
died;  but  it  is  very  interesting  to  note  that  there  was  no  fever. 
This  may  be  explained  by  the  fact  that  many  cases  of  insanity 
and  idiocy  stand  in  etiological  relation  to  alterations  of  the 
thyroid  gland,  and  may  get  better  after  the  hyperactivity  of 
the  thyroid  through  fever.  Indeed,  by  some  authors, — e.g. 
Wagner — an  improvement  has  been  observed  to  occur  in  insanity 
by  producing  fever  through  injections  with,  tuberculin.  We  feel 
sorry  not  to  be  able  to  enter  more  fully  into  this  interesting  sub- 
ject, but  we  may  briefly  mention  that,  as  we  have  stated  in  the 
Neurological  Society  of  New  York  (April  2,  1906),  we  have 
observed  several  cases  of  dementia  prsecox  and  melancholia  with 
alterations  of  the  thyroid  and  sexual  glands  in  each  case.  Alco- 
holics suffering  from  pneumonia  seldom  get  high  fever,  but  often 
die  in  a  short  time.  Alcohol  in  large  quantities  not  only  causes 
degenerative  changes  in  the  heart,  but  also  in  the  thyroid.  And 
we  should  not  forget  that  there  exist  very  close  relations  between 
the  activity  of  these  two  organs. 

It  seems  to  follow  from  these  observations  that  persons  with 
a  good  sound  thyroid  have  a  better  chance  in  fighting  infections 
and  intoxications  than  persons  with  a  degenerated  thyroid.  In 
persons  with  an  active  thyroid,  an  increased  activity  of  the  gland, 
and  thus  a  better  functioning  of  the  eliminative  organs  which 
are  governed  by  it,  can  take  place  more  easily  than  in  persons 
with  a  degenerated  thyroid,  and,  in  consequence,  with  a  dry  skin, 
constipated  bowels,  and  lazy  kidneys.  Some  hints  may  be  derived 
from  these  observations  in  the  interest  of  prophylaxis  and  prog- 
nosis, and  also  for  the  purposes  of  life  insurance. 

It  seems  to  us  that  the  conclusion  is  not  unjustified,  that 
fever  is  a  beneficial  process  of  our  organism  which  is  produced 
by  an  increased  activity  of  the  thyroid  gland  as  a  reaction 
against  toxic  products  and  poisons  in  general.  The  symptoms 
of  fever  are  the  expression  of  this  increased  activity,  and  they 


Immunity  Against  Infections  and  Intoxications.  31 

are  directed  toward  the  elimination  of  noxious  elements.  It 
would  be  unreasonable  to  oppose  this  spontaneous  healing  ten- 
dency of  nature  by  fighting  these  salutary  symptoms,  unless  there 
be  hyperpyrexia.  Fever,  as  probably  disease  in  general,  serves 
the  ends  of  nature  in  the  interest  of  our  conservation.  In  addi- 
tion to  the  thyroid,  the  other  ductless  glands  protect  us  from 
infections  and  intoxications.  Thus,  the  pituitary  body  which 
Casselli,29  Guerrini,30  Torri,  and  many  others  found,  as  a  rule, 
altered  through  infectious  diseases.  Torri  noticed  a  hyperplasia 
of  the  chromophile  cells  of  the  pituitary  body,  and  disappearance 
of  the  colloid  from  the  follicles  in  the  majority  of  cases  of  pneu- 
monia, typhoid  fever,  tuberculosis,  diphtheria,  and  other  infec- 
tious diseases.  Gamier  also  noted  changes  in  this  gland  in 
chronic  tuberculosis.  Thaon,31  in  his  recent  thesis,  also  found 
changes  in  the  pituitary  body  in  many  cases  of  various  sorts  of 
infectious  disease,  and,  what  is  most  interesting,  also  in  intoxi- 
cations from  intestinal  origin.  We  must  conclude  with  Sajous 
(1903)  that  the  pituitary  body  reacts  to  the  effects  of  infections 
and  intoxications  and  that  these  anatomo-pathological  alterations 
of  the  pituitary  also  provoke  clinical  symptoms.  Renon32  and 
Delille  have  drawn  attention  to  the  fact  that  the  decrease  of  the 
blood-pressure,  and  increase  in  the  number  of  pulsations,  in  fever, 
as  also  the  other  symptoms  of  this  condition,  such  as  insomnia, 
heat,  perspiration,  etc.,  are  due  to  the  alteration  of  the  pituitary 
body.  When  this  is  active  and  healthy  it  augments  blood- 
pressure,  according  to  Oliver  and  Schafer,33  Cyon,  Livon, 
Gamier,  Thaon,  Hallion,  and  Carrion,  etc.  At  the  same  time  the 
pulse  is  diminished,  but  when  this  gland  is  degenerated  the  pres- 
sure naturally  falls  and  the  pulsation  goes  up. 


29  Studie  anatomici  e  sperimentali  sulla  psycho-pathologia  della  glandula 
pituitaria,  Reggio  Emilia,  1900. 

30Revista  di  Patol,  nerv.  e  mentale,  Nov.,  1904;  and  La  Sperimentale, 
lviii.,  1904. 

31  These  de  Paris,  1907. 

32  Soeiete  de  therapeutique,  Jan.  22,  1902. 
**  Journal  of  Physiology,  t.  xviii,  1895. 


32  Old  Age  Deferred. 


It  is  also  very  interesting  that  Renon,  with  his  assistants, 
Delille  and  Azam,34  were  able  to  increase  blood-pressure  in 
numerous  cases  of  infectious  diseases  and  diminish  the  pulse, 
and  also  produce  a  marked  improvement  in  the  feverish  condi- 
tion through  the  administration  of  extracts  of  the  pituitary  body. 

We  must  insist  on  the  fact  that  the  thyroid  and  the  pituitary 
body  are  antagonistic ;  the  thyroid  diminishes,  the  pituitary  aug- 
ments, blood-pressure.  The  same  antagonistic  relations  exist 
also  between  the  thyroid  and  adrenals,  as  already  mentioned. 

The  adrenals  play  an  important  role  also  in  the  defense  of 
the  organism  against  infections  and  intoxications,  as  we  will 
point  out  in  a  separate  chapter.  We  will  only  recall  here  that 
already  (1903)  Sajous35  has  insisted  upon  the  important  role 
of  the  adrenals  in  the  production  of  fever. 

The  co-operation  of  the  sexual  glands  in  protecting  the 
body  from  infectious  disease  can  be  shown  by  the  fact  found 
by  Professor  Cornil,36  of  Paris,  that  in  infectious  diseases,  such, 
for  instance,  as  typhoid  fever,  there  is  frequently  sudden  men- 
struation, with  abundant  metrorrhagia,  the  autopsy  often  show- 
ing hypertrophy  of  the  corpus  luteum. 

Metschnikoff37  and  Matschinski  found,  after  injections  of  the 
bacilli  of  tetanus,  or  of  diphtheria,  the  greatest  number  of  them 
in  the  ovaries,  or  in  the  testicles,  of  the  animals.  It  is  also  of 
great  interest  that  Lingard38  found  that  the  subcutaneous  injec- 
tion of  testicular  extracts  into  cattle  induces  a  resistance  to  in- 
fection from  bovine  plague,  against  which  other  cattle  can  also 
be  rendered  immune  through  the  serum  of  the  treated  animals — 
which  seems  very  important  to  us.  Brown-Sequard  and  d'Arson- 
val  employed  testicular  extracts  with  good  result  in  tuberculosis, 
and  Uspenski  in  cases  of  Asiatic  cholera.388. 


34 Azam:     These  de  Paris,  1907. 

35  "Internal  Secretions,"  vol.  i3  p.  33. 

36  Quoted  after  Loisel. 

37  Metschnikoff :     Annales  de  Pinstitut  Pasteur,  1900. 

38  Lingard:     Centralblatt  fiir  Bacteriologie,  vol.  xxxviii,  Nu.  2,  p.  246. 
38a  Comptes  Rendus  de  la  Societe  de  Biologie  de  Paris,  Nov.  5,  1896. 


Immunity  Against  Infections  and  Intoxications.  33 

In  the  chapter  on  the  treatment  of  old  age  by  organic 
extracts,  we  submit  evidence  showing  that  infectious  diseases 
have  been  treated  successfully  by  several  authors  by  these  ex- 
tracts. Many  others  have  also  shown  that  spermin,  prepared 
by  Professor  Poehl  from  the  testicles  of  various  animals,  has 
also  a  marked  effect  against  different  infectious  diseases,  some- 
times even  in  cases  of  desperate  septicaemia.  It  has  been  shown 
by  Professor  Loewy  and  Dr.  Richter,  that  after  giving  spermin 
there  is  at  first  a  great  diminution  of  the  leucocytes  in  consequence 
of  leucolysis,  which  is  soon  followed  by  hyperleucocytosis,  and  at 
the  same  time  there  was  considerable  increase  of  alkalinity  in 
the  blood.39 

Loewy  and  Richter  were  able  to  cure  animals  by  injecting 
spermin  even  in  cases  of  experimental  pneumonia,  where  they 
had  received  three  or  four  times  the  fatal  dose  of  pneumococci. 
These  observers  also  tried  spermin  in  diphtheria,  but  here  the 
results  were  less  marked,  although  in  some  cases  where  the  exact 
fatal  dose  was  given,  a  cure  was  effected.  According  to  Pro- 
fessor Poehl40  the  increase  of  alkalinity  of  the  blood  through 
spermin,  explains  its  action  to  increase  immunity  against  infec- 
tion. Sajous  also  urges  that  immunity  is  closely  related  with 
alkalinity. 

It  is  interesting  to  observe  that  spermin  has  also  given  good 
results  in  intoxication  through  leucomaines,  which  play  a  great 
role  in  autointoxications  in  the  body.  This  applies  to  neurin 
and  cholin,  as  noted  by  Professor  Prince  Tarchanow,  and  Dr. 
Poehl. 

We  have  already  mentioned  that  the  thyroid  protects  us 
against  various  poisons,  such  as  chloroform,  and  it  is  of  interest 
to  note  that  the  testicles  may  also  have  a  similar  action ;  for,  as 
Tarchanow  has  shown  in  frogs,  and  also  dogs,  after  injection 
of  spermin,  these  animals  were  better  able  to  resist  chloro- 
form narcosis,  and  could  also  withstand  a  greater  dose  of  it. 

39  Richter :     Organotherapie. 

40  Poehl :     Organotherapie,  vol.  i,  St.  Petersburg,  1905. 

3 


34  Old  Age  Deferred. 


Weljaminoff  found  the  same  also  in  man.  Kriiger  found  that 
this  applied  also  to  ether  narcosis. 

The  liver,  as  we  shall  show  later  in  a  separate  chapter,  also 
antagonizes  intoxication.  Another  organ  in  close  relation  to  the 
ductless  glands — especially  in  infants — the  thymus,  must  also  be 
considered  in  the  same  way  as  the  spleen  as  taking  an  important 
part  in  our  protection  against  infections.  As  well  known,  the 
spleen  is  a  foremost  organ  for  the  production  of  protective  sub- 
stances, the  frequent  swelling  of  the  spleen  in  infectious  diseases 
shows  its  co-operation  in  the  defense  of  the  body  (see  also  Chap- 
ter X).  Respecting  the  thymus,  it  has  been  shown  by  Brieger, 
Kitasato,  and  Wassermann,  that  cultures  of  cholera  bacilli  lose 
their  toxic  action  in  extracts  of  the  thymus. 

There  can  be  no  doubt  whatever,  from  the  foregoing,  that 
our  immunity  against  infections  and  intoxications  depends  on 
the  intact  condition  of  the  ductless  glands,  the  great  importance 
of  which,  as  defensive  organs,  has  been  demonstrated  and  ex- 
plained by  Professor  Sajous  in  1902.41  As  he  says :  "The  over- 
activity of  the  adrenal  system  is  the  inciting  factor  of  leuco- 
cytosis,  and,  therefore,  of  phagocytosis ;"  and  later  in  the  second 
volume:  "that  the  adrenal  system,  composed  of  the  pituitary 
body,  the  adrenals,  and  the  thyroid  apparatus,  constitutes  the 
immunizing  mechanism  of  the  body." 

When  the  ductless  glands  are  not  in  good  working  condi- 
tion, there  are  three  principal  things  which  can  occasion  infec- 
tion or  intoxication.  These  are  deficient  nutrition,  exposure  to 
cold,  and  a  depressed  mental  condition.  By  these  the  resistance 
of  the  cells  against  the  energy  of  the  invading  microbes  is  low- 
ered, and  the  greater  the  invasion  the  easier  will  be  their  victory. 

We  will  often  refer  to  this  in  the  chapters  on  personal 
hygiene,  and  propose  certain  remedies  for  avoiding  these  pre- 
disposing sources  of  infection  and  intoxication. 


41  Sajous:      "Internal  Secretions,"  vol.  i,  p.  624,  1903    (see  also  vol.  ii,  p. 
13,  1907). 


CHAPTER  IV. 

On  the  Agencies  that  Govern  the  Condition  of  the 
Nervous  System  and  Mentality. 

By  treating  with  thyroid  extracts  a  child  that  has  remained 
backward  in  his  mental  development  we  can  make  a  curious  ob- 
servation. The  child  who  had  previously  been  a  cretinous  idiot 
will  not  only  improve  bodily  but  also  mentally,  and  he  will  be 
transformed  into  an  intelligent  being  with  normal  mental  facul- 
ties. The  logical  deduction  is  that  the  thyroid  must  influence 
powerfully  the  condition  of  our  nervous  system  and  mentality. 
Indeed,  the  physiological  activity  of  the  nervous  system  and  men- 
tality depends  entirely  on  the  co-operation  of  the  ductless  glands 
with  internal  secretion.  In  fact,  we  do  not  think  we  are  going 
too  far  in  saying  that  the  condition  of  the  nervous  system  and 
mentality  is  mainly  governed  by  these  glands.  The  truth  of  this 
assertion  is  shown  by  the  fact  that  any  alteration  of  these  glands, 
especially  the  thyroid  and  sexual  glands,  and  pituitary  body,  is 
always  followed  by  alterations  of  the  nervous  system.  This 
is  strikingly  sustained  by  the  elaborate  researches  of  Sajous  who 
found  that  the  reactions  of  fluids  circulating  in  all  nervous  ele- 
ments corresponded  with  those  of  internal  secretions  and  par- 
ticularly that  of  the  adrenals. 

Removal  of  the  thyroid  also  produces  far  reaching  anatomical 
changes  in  the  central  part  of  the  nervous  system  which,  as  we 
have  mentioned,  has  been  described  by  Albertoni,  Tizzoni1 
Blum,2  Walter  Edmund,3  and  others.  These  consisted  of  the 
destruction  of  nervous  cells  and  nervous  processes,  chromato- 


1  Arch,  per  le  scienze  Mediche,  vol.  x.,  p.  45,  1886. 

2  Blum:     Virchow's  Archiv,  1899. 

3  Walter  Edmunds :     Transact,  of  the  Path.  Soc.  of  London,  vol.  liii.,  Part 
3,  p.  343,  1902. 

(35) 


36  Old  Age  Deferred. 


lysis,  and  also  the  augmentation  of  the  neuroglia,  which  increases 
in  the  same  way  as  the  connective  tissue  in  all  other  organs  and 
tissues. 

These  changes  have  been  found  by  Whitwell4  also  in  myx- 
cedematous  persons.  In  accordance  with  these  anatomo-patho- 
logical  changes  we  must  also  expect  clinical  symptoms,  and  we 
shall  thus  find  in  persons  with  degenerated  thyroids  an  idiotic 
condition  termed  cretinism,  while  in  persons  suffering  from 
myxcedema  mentality  is  considerably  altered.  Thus  Pilcz5  notes 
as  typical  symptoms  of  myxcedema :  slowness  of  thought, 
apathy,  defective  memory,  and  somnolence.  In  fact,  after  re- 
moval of  the  thyroid  gland  or  after  its  degeneration  by  disease, 
we  observe  changes  in  all  those  functions  which,  according 
to  our  present  knowledge  of  physiology,  are  situated  in  the 
cortex  cerebri,  such  as  intelligence,  power  of  imagination,  will 
power,  memory,  sleep,  etc.  The  thyroid  must  govern  these  func- 
tions, as  they  are  seriously  damaged  after  the  degeneration  of 
this  gland.  Thus,  myxcedematous  people  think  and  speak  very 
slowly,  have  a  weakened  intelligence,  are  completely  apathetic, 
and  have  no  will  power,  and  the  memory  is  either  gone  or  is 
defective.  In  the  same  way,  as  in  old  age,  myxcedematous  people 
can  remember  events  which  have  happened  a  long  time  ago,  but 
cannot  do  so  as  regards  recent  events — all  facts  we  explain  by 
assuming  they  are  able  to  remember  what  has  happened  at  the 
time  prior  to  the  degeneration  of  the  thyroid;  but  after  such 
a  condition  they  are  not  able  to  mirror  recent  events  in  the 
greater  brain.  The  wonderful  effect  of  the  thyroid  on  intelli- 
gence can  be  observed,  as  above  mentioned,  in  backward  or 
cretinous  children  who,  by  means  of  the  thyroid  extract,  become 
intelligent  children  gifted  with  a  better  memory.  We,  ourselves, 
through  personal  observation  and  experiments,  observed  the  fact 
that  thyroid  tablets  improve  the  memory  (see  also  Chapter  LIII), 


4  Whitwell:     British  Med.  Journal,  p.  730,  Feb.  1892. 

5  Quoted  after  Oppenheim:     "Lehrbuch  der  Nervenkrankheiten,"  p.  1383, 
Berlin,  1906. 


Agencies  Governing  Nervous  System  and  Mentality.       37 

and  it  is  interesting  to  mention  here  the  case  of  a  very  stout 
patient  who,  after  the  first  clay  of  thyroid  treatment,  felt  in  such 
a  condition  of  mental  activity  that  he  sat  down,  in  the  middle  of 
the  night,  at  his  writing  table  to  compose  a  scientific  article  in- 
stead of  going  to  sleep.  We  did  not  mention  to  this  gentleman — 
a  lawyer — anything  about  the  effects  that  the  thyroid  might  have. 
Dr.  Hertoghe,  the  well-known  authority  on  the  thyroid  gland, 
told  us  that  he  sometimes  takes  before  strenuous  mental  work, 
such  as  the  delivery  of  a  lecture,  three  or  four  thyroid  tablets  at 
a  single  dose.  We  must  not,  however,  allow  ourselves  to  be 
seduced  to  thyroid  medication  by  the  action  of  thyroid  on  men- 
tality, unless  the  condition  of  our  gland  demands  it,  for  the  ad- 
ministration of  such  extracts  in  large  doses  and  without  special 
diet  and  precautions  may  produce  disagreeable  symptoms,  a 
description  of  which  we  will  give  in  a  special  chapter  on  the  treat- 
ment of  old  age  by  means  of  extracts  from  the  organs  of  animals. 

We  have  also  frequently  seen  a  marked  improvement  in  the 
mental  faculties  of  adults  through  thyroid  treatment.  Thus  last 
winter,  during  a  stay  in  Nice,  we  were  consulted  by  an  American 
lady  of  69  years  who  was  suffering  from  arteriosclerosis  and 
dizziness.  Through  thyroid  treatment  the  intelligence  of  this  lady 
improved  so  much  that  it  became  very  noticeable  to  her  English 
trained  nurse,  who  told  us  that  whereas  before  she  could  do  any- 
thing with  this  mentally  torpid  woman  without  comment,  now  she 
first  demanded  to  know  the  reason  for  everything  before  she  com- 
plied with  the  dietary  and  hygienic  measures  the  nurse  wanted 
her  to  follow. 

That  the  thyroid  gland  affects  the  intellect  is  also  proved  by 
the  very  important  fact  that  the  serum  of  animals  whose  thyroid 
has  been  extirpated,  and  which  is  thus  antagonistic  to  the  thyroid 
gland,  is  able  to  impair  the  intellect.  Diirig5a  noticed  this  after 
using  large  doses  of  such  serum  in  a  woman  with  Graves's  disease, 
thereby  causing  an  appearance  of  great  stupidity,  loss  of  memory, 


5aDurig:     Munchener  Med.  Woch.,  1908,  Nu.  18. 


38  Old  Age  Deferred. 


and  incapability  of  thinking,  so  that  he  had  to  suspend  the  treat- 
ment. These  symptoms  continued  for  fourteen  days  after  the 
treatment  had  been  discontinued. 

Sleep  is  also  one  of  the  functions  controlled  by  the  thyroid, 
and  as  its  changes  are  able  to  promote  senility,  we  believe  it 
will  be  well  to  discuss  this  more  fully  in  a  special  chapter 
(XLIII). 

We  cannot  recall  any  alteration  of  the  thyroid  gland  that 
is  not  accompanied  by  nervous  symptoms.  In  Graves's  disease 
(exaggerated  activity  of  the  thyroid)  we  observe  a  condition  of 
great  nervousness,  so  much  so  that,  according  to  some  authori- 
ties, Graves's  disease  may  be  termed  a  neurasthenia  with  tachy- 
cardia. There  are  many  women  treated  for  simple  hysteria 
who  are,  in  fact,  suffering  from  a  partial  form  of  Graves's 
disease  with  its  cardinal  symptom:  tachycardia.  In  cases  of 
Graves's  disease  we  often  find  conditions  of  exaltation,  even 
manias,  and  very  frequently,  at  the  very  least,  great  irritability. 
On  the  other  hand,  in  myxcedema  there  is,  usually,  a  condition 
of  melancholia,  and  it  is  interesting  in  this  connection,  that  in 
a  number  of  cases  of  melancholia  we  have  found  a  swelling  of 
the  thyroid  with  a  cessation  of  the  menstrual  flow;  such  cases 
improved  after  thyroid  treatment,  particularly  when  conjoined 
with  treatment  by  ovarian  extracts.  In  the  lunatic  asylum  of 
Pontiac,  Michigan,  some  ioo  cases  of  swelling  of  the  thyroid 
have  been  traced  out  of  600  insane  inmates,  as  we  heard  on  the 
occasion  of  our  visit  to  our  friend,  Dr.  Edwin  S.  Sherril,  of 
Detroit,  four  years  ago. 

As  we  have  seen  already,  the  thyroid  stands  in  very  close 
relation  to  the  ovaries,  and,  as  we  have  often  stated,  the  altera- 
tion of  the  ovaries  is  very  apt  to  produce  a  swelling  of  the  thy- 
roid, as  witnessed  during  menstruation,  puberty,  pregnancy,  the 
puerperium,  lactation,  and  the  climacteric.  Not  only  may  the 
thyroid  swell  in  many  of  these  conditions,  but  the  mental  sys- 
tem is  also  changed  during  each  of  these  processes.  Sometimes 
it  may  be  simple  irritability,  but  at  times  the  changes  of  the 


Agencies  Governing  Nervous  System  and  Mentality.       39 

mind  may  develop  into  lunacy.  Thus,  in  young  girls,  we  occa- 
sionally see  in  the  years  of  puberty  mental  changes,  such  as  a 
tendency  to  wandering  away  from  home,  and  even  cases  of 
lunacy,  the  so-called  psychoses  of  puberty.  Similar  cases  of 
insanity  are  equally  frequent  in  pregnancy,  and  during  the  cli- 
macterium or  after  the  -  experimental  climacterium — castration. 
Again,  insanity  is  not  unfrequent  in  cases  of  degenerative  dis- 
ease of  the  ovaries;  to  such  an  extent,  indeed,  that  sometimes 
a  gynaecologist  can  treat  a  case  of  insanity  in  women  better  than 
a  specialist  in  psychiatry.  Not  only  in  women,  but  in  men 
changes  in  the  sexual  organ  always  produce  far-reaching  changes 
in  the  mind.  Chronic  gonorrhoea  is  the  more  to  be  feared  on 
account  of  its  invariably  involving  the  prostate,  the  inflammation 
of  which,  in  the  same  way  as  that  of  the  testicles,  is  usually 
followed  by  symptoms  of  neurasthenia.  If  we  now  note  this  and 
remember  that,  according  to  Baldwin,  in  most  cases  of  hysteria 
we  may  find  at  the  autopsy  alterations  in  the  ovaries,  we  shall 
understand  that  the  author  of  this  book  did  not  go  too  far  when 
he  stated,  in  a  communication  to  the  Belgian  Congress  of  Neu- 
rologists, in  Brussels,  in  1906,  that  all  cases  of  neurasthenia  and 
hysteria  are  based  upon  pathological  anatomical  alterations,  and 
that  it  is  not  true  that,  in  contra-distinction  to  all  other  diseases, 
these  should  be  the  only  ones  without  any  pathological  ana- 
tomical foundations.  In  fact,  in  nearly  all  cases  of  neurasthenia 
or  hysteria  we  shall  find  changes  in  some  of  the  ductless  glands, 
particularly  the  thyroid,  sexual,  or  pituitary  body,  if  we  only 
take  the  trouble  to  search  for  them.  The  degenerative  altera- 
tions of  the  pituitary  body  are,  as  a  rule,  followed  by  the  symp- 
toms of  the  disease  called  acromegaly,  and  this  also  presents  all 
the  symptoms  of  a  neurasthenic  or  hysteric  condition. 

From  the  foregoing  we  shall  understand  why  so  many 
people,  whether  male  or  female — possibly  the  latter  in  greater 
number — who  live  in  total  sexual  abstinence,  present  symptoms 
of  neurasthenia  or  hysteria;  for  it  has  been  shown  by  Rigaud 
and  also  by  Mingazzini,  that  animals,  living  in  total  sexual 


40  Old  Age  Deferred. 


abstinence,  present  alterations  in  the  epithelia  of  the  sexual 
glands  (see  Chapter  XLVII). 

It  would  be  simply  hypocrisy  and  unworthy  of  a  scientific 
work  which  should  always  aspire  to  reveal  the  truth,  were  we 
to  deny  the  fact  that  many  old  bachelors  and  spinsters  present 
a  series  of  nervous  symptoms,  especially  dyspepsia  and  hyper- 
chlorhydria  and  pains  in  the  stomach,  far  more  than  other  per- 
sons, which  we  must  explain  by  the  action  of  impulses  coming 
from  the  sexual  organs  to  the  sympathetic  and  pneumogastric, 
the  principal  nerves  of  the  stomach  and  intestines,  and  thus  pro- 
ducing a  hyperesthesia  of  the  nerves  of  the  stomach.  In  such 
persons  some  kinds  of  food,  well  digested  by  a  normal  stomach, 
will  act  as  an  injurious  foreign  body,  and  be  felt  as  such  by 
the  over-sensitive  stomach  nerves,  and  the  gastric  glands  will 
respond  with  a  large  flow  of  secretion  and  much  acid  upon 
agencies  that  produce  no  such  stimulation  in  a  normal  stomach. 

That  the  sexual  glands  also  influence  the  intellect  is  best 
proved  by  the  observation  that  in  cases  of  testicular  or  ovarian 
insufficiency  intelligence  is  often  diminished.  Thus  we  were  con- 
sulted by  the  parents  of  a  young  man  of  eighteen  years  who  was 
mentally  backward;  he  could  not  remember  anything;  his  arms 
and  legs  were  abnormally  long,  but  his  body  short,  thus  resem- 
bling a  eunuch's — and  indeed  I  found  his  testicles  were  not  yet 
descended.  His  voice  was  that  of  a  child,  and  he  also  exhibited 
the  other  symptoms  of  testicular  insufficiency  described  in  the 
second  chapter  of  this  book. 

On  the  other  hand  we  may  see  a  precocious  highly  developed 
intellect  in  children  with  a  premature  sexual  development.  We 
know  of  a  boy  of  six  years  who  tried  to  have  sexual  intercourse 
with  a  little  girl  of  the  same  age,  and  who  at  the  age  of  four  and 
one-half  years  knew  all  the  capitals  of  the  world  by  heart. 
Hence  the  education  of  precociously  bright  children  should  be 
especially  guarded,  for  they  can  become  great  men  but  also  not 
rarely,  if  neglected,  great  criminals. 

As,  however,  in  these  days  of  scepticism  we  do  not  believe 


Agencies  Governing  Nervous  System  and  Mentality.       41 

in  anything  until  demonstrated  by  experiments  (often  forgetting 
the  fact  that  what  does  for  dogs  or  rabbits  does  not  always  do 
for  man)  which  should  only  assist  our  judgment,  but  not  exclu- 
sively govern  it,  we  shall  have  to  prove  the  correctness  of  our 
clinical  observations  on  the  influence  of  the  sexual  glands — i.e., 
on  the  nervous  system  and  mentality — by  experiment,  and  we 
believe  we  have  sufficient  facts  at  hand  to  do  so. 

About  a  hundred  years  ago  it  was  shown  by  Gall — who  was 
attacked  by  several  authors,  among  them  Rieger,  as  innovations 
always  are,  but  who  was  also  successfully  defended  by  the  cele- 
brated German  nerve  specialist  and  philosopher,  Moebius6 — that 
castrated  animals  or  persons  have  an  alteration  in  the  back  part 
of  the  skull  indicating  an  impoverishment  of  the  cerebellum.  And, 
indeed,  he  produces  his  own  evidence  and  that  of  several  other 
authorities,  Darnecy,  Rousseau,  etc.,  which  gives  the  history  of 
several  autopsies  on  castrated  persons,  all  of  whom  showed  an 
atrophy  of  this  structure.  In  cases  where  only  one  of  the  tes- 
ticles was  destroyed,  this  atrophy  was  always  present  in  the 
hemisphere  of  the  small  brain  on  the  opposite  side. 

It  has  been  found  by  numerous  authorities  that  the  skull 
and  brain  of  castrated  animals  and  persons  is  smaller  than  the 
normal.  Gall7  noted  this  fact,  and  after  him  Vimont,8  from 
experiments  on  animals ;  and,  according  to  the  latter  observer 
castration  of  both  sides  produces  a  considerable  diminution  of 
the  cerebellum.  Leuret  and  Hoffmann9  found  a  diminution  of 
the  head  in  horses,  sheep,  and  pigs  after  such  an  operation, 
and  that  the  other  parts  of  the  skeleton  are  always  altered  is  a 
fact  recorded  by  a  large  number  of  authorities  as  stated  already. 

As  we  have  pointed  out  above,  any  alteration  of  the  testi- 


6 Moebius:     "Die  Wirkungen  der  Castration,"  Halle,  1902. 

7 Gall:  "Anatomie  et  Physiologie  du  Systeme  nerveux,"  T.  iii.,  p.  108, 
Paris,  1818. 

8 Vimont:  "Trait§  de  Phrenologie  humaine  et  comparee,"  two  vols,  et 
atlas,  vol.  ii.,  p.  233,  Paris,  1835. 

9  Hoffmann :  "Ueber  die  Castration  der  Hausthiere  Schneidermuhls  Thier- 
medecin,"  Vortrage  ii.,  12.  1892. 


42  Old  Age  Deferred. 


cles  or  ovaries  is  followed  by  nervous  disturbances,  and,  conse- 
quently, the  total  removal  of  these  glands  produces  far  more 
deleterious  effects,  and  these  will  vary  according  to  whether  such 
persons  have  been  castrated  at  an  early  age  or  later.  In  these 
latter  cases  nervous  disorders  will  be  more  acutely  felt,  and  as 
the  celebrated  French  authority,  Dupuytren,  states,  melancholia 
is  a  common  phenomenon  in  castrated  men.  According  to 
more  recent  observations  in  cases  of  enlargement  of  the  pros- 
tate that  have  been  treated  by  castration,  the  patients  exhibit 
melancholia.  We  may  here  remark  that  the  testicles  and  the 
prostate  are  in  close  relation,  the  latter  always  becoming  atro- 
phied after  castration.  There  is  experimental  evidence  to  show 
that  a  too  large  amount  of  testicular  or  ovarian  secretion  may 
produce  toxic  effects.  Thus,  Loisel,  by  injecting  testicular  or 
ovarian  extracts  into  animals,  could  produce  toxic  symptoms 
in  every  instance.  This  may  account  for  the  fact  mentioned 
previously  that  persons  living  for  a  long  time  in  complete  sexual 
abstinence,  occasionally  exhibit  symptoms  of  disorder  of  the 
nervous  system. 

The  marvelous  influence  of  the  sexual  glands  on  the  mind 
and  character  is  at  once  apparent  if  we  consider  the  aberration 
from  the  normal  of  the  castrated  person.  The  authorities  who 
have  studied  the  eunuchs  in  Egypt  and  the  Skopze  in  Russia 
(a  religious  sect  who  adopt  castration  as  a  tenet),  found  typical 
characteristics  in  these  people  that  distinguished  them  from 
the  normal. 

Thus,  as  a  rule  (and  as  stated  by  Moebius),  the  biography 
of  remarkable  eunuchs  of  the  old  and  middle  ages  shows  that 
they  are  entirely  deficient  in  courage,  which  seems  to  be  de- 
pendent entirely  on  the  possession  of  testicles,  and  the  same  fact 
may  be  noted  also  in  the  case  of  the  lower  animals.  Thus,  an 
ox  is  a  coward  compared  to  a  bull,  and  an  ordinary  horseman 
prefers  to  ride  a  mare  rather  than  a  stallion.  The  best  means  of 
taming  certain  animals  is  by  depriving  them  of  their  testicles  at 
an  early  age.     Intelligence  also  is  much  influenced,  not  only  by 


Agencies  Governing  Nervous  System  and  Mentality.       43 

the  thyroid,  as  already  shown,  but  by  the  testicles.  Thus  per- 
sons of  literary  or  other  fame,  such  as  artists  and  the  like,  have 
become  impaired  in  their  capacity  after  castration :  Abelard,  for 
example. 

Moebius,  in  the  history  of  the  world,  could  find  no  castrates 
of  great  intelligence.  Knowledge  gained  by  diligent  labor  is 
not  referred  to  here.  We  merely  wish  to  express  our  conviction 
that  great  ideas,  such  as  are  found  in  men  of  genius,  are  impos- 
sible in  men  devoid  of  their  testicles ;  and  it  appears  out  of  the 
question  to  imagine  such  men  as  Napoleon,  Goethe,  or  others, 
as  castrates.  On  the  contrary,  we  are  inclined  to  believe  that 
such  great  men  had  a  private  life  that  would  have  rendered  them 
unfit  for  the  position  of  superintendent  of  an  American  Sunday 
School. 

Courage  is  a  specific  feature  that  can  only  be  found  in  a  man 
who  is  still  in  possession  of  healthy  sexual  glands ;  it  is  entirely 
wanting  in  eunuchs.  Cowardice,  superstition,  laziness,  avarice, 
vanity,  cruelty,  and  other  bad  qualities  are  typical  features  in 
eunuchs.  Our  friend  Sir  Hugh  Adcock,  formerly  physician  to 
the  late  Shah  of  Persia,  told  us  that  his  own  experience  with 
hundreds  of  eunuchs  showed  him  that  they  all  had  these  bad 
qualities.  Capacity  for  hard  work,  generosity,  kind-heartedness, 
and  religion  may  be  found  in  persons  who  are  in  the  possession 
of  healthy,  vigorous,  sexual  glands;  but  by  exhaustion,  after 
sexual  excesses,  a  condition  may  be  created  analogous  to  myx- 
cedema  after  previous  Graves's  disease.  This  exhaustion  of  the 
sexual  glands  may  create  a  condition  in  which  some  of  the  feat- 
ures of  the  castrated  may  appear.  This  is  noticeable  in  the 
character  of  many  of  the  dignitaries  of  oriental  countries  who 
possess  large  harems,  and  also  in  occidental  countries  in  many 
men  who  lead  a  life  of  debauchery.  The  influence  of  the  pituitary 
is  shown  by  changes  that  invariably  occur  in  the  nervous  system 
and  mind  after  any  alteration  in  it.  Thus,  in  two  millionaires 
suffering  from  acromegaly  we  have  observed  great  stinginess. 
We  do  not  intimate  that  this  is  a  characteristic  of  millionaires, 


44  Old  Age  Deferred. 


but  these  gentlemen  were  quite  the  reverse  before  becoming 
afflicted  with  their  disease.  In  one  case  of  acromegaly,  for  the 
knowledge  of  which  we  are  indebted  to  Dr.  Dercum  of  Philadel- 
phia, there  was  a  great  distrust  of  anything  new,  even  the  most 
useful  of  innovations.  This  caused  great  discontent  among  the 
gentleman's  business  partners,  although  he  himself  showed  this 
disposition  only  after  the  symptoms  of  his  disease  were  apparent. 
In  acromegaly  there  exists  a  hyperactivity  of  the  pituitary ;  Renon 
was  able  to  produce  the  disease  by  giving  large  doses  of  pituitary 
extracts,  and  Hochenegg  obtained  good  results  in  his  treatment 
of  it  by  extirpating  the  pituitary  body. 

Extirpation  of  the  adrenals  is  also  followed  by  important 
alterations  in  the  nervous  system,  as  was  noted  by  Jersoni  and 
others.  Also,  in  Addison's  disease,  which  is  accompanied  by  a 
degeneration  of  these  glands,  we  notice  a  diminution  of  the  intel- 
lect together  with  a  general  mental  depression. 

The  influence  of  the  ductless  glands  on  character,  and  the 
change  in  the  same  after  alterations  in  those  glands,  may  easily 
lead  to  crime,  as  the  two  principal  barriers  against  crime  are 
will  power,  by  which  we  control  our  passions ;  and  sound  judg- 
ment, by  which  we  distinguish  right  from  wrong.  It  is  evident 
that  a  cretinous  or  myxedematous  person  will  have  no  great 
will  power,  for  this,  as  already  shown,  is  dependent  on  the  thy- 
roid secretion;  nor  do  they  possess  intelligent  sound  judgment 
enough  to  realize  what  is  right ;  and,  as  the  possible  consequences 
of  their  defective  action,  castrated  persons,  as  above  shown,  are 
more  attracted  to  crimes  due  to  avarice  or  cruelty.  Those  who 
are  interested  in  this  question  may  read  our  lecture  delivered 
before  the  Medical  Jurisprudence  Society  in  Philadelphia,10  in 
which  we  endeavored  to  prove  in  detail  our  assertions  that  the 
origin  of  crime  is  due  to  nervous  changes  succeeding  alterations 
of  the  ductless  glands.  As  persons  of  advanced  age  often  have  a 
complete  atrophy  of  the  sexual  glands,  changes  in  their  char- 
acter may  be  explained  on  these  grounds. 

10  Journal  of  the  American  Med.  Association,  May  10,  1907. 


CHAPTER  V. 

On  the  Influence  of  the  Sexual  Glands  upon  Vitality 

and  Long  Life. 

When  we  study  the  history  of  people  who  present  a  youth- 
ful appearance  late  in  life,  and  reach  an  extraordinary  old 
age, — up  to  1 20  or  140,  or  even  160, — we  are  surprised  at 
the  unmistakable  evidence  of  a  strong  sexual  activity  in  most 
of  them,  which  is  only  possible  by  being  possessed  of  healthy 
and  active  sexual  glands;  and  thus  it  would  appear  that  the 
possession  of  such  glands  may  impart  a  strong  vitality  and  the 
best  chances  for  a  long  life.  That  such  is  the  case  we  will  en- 
deavor to  show  by  evidence  of  an  experimental  nature,  and  also 
by  facts  gathered  from  observation  of  the  long  lives  of  the 
patriarchs. 

When  the  sexual  glands  of  a  person  are  extirpated,  such 
castrated  people,  be  it  man  or  woman,  soon  get  old.  This  we 
can  see  in  the  case  of  eunuchs  who  get  wrinkled  even  in  their 
youth,  such  also  get  fat,  and  present  other  symptoms  of  prema- 
ture old  age;  and  the  same  is  observable  in  women  whose 
ovaries  have  been  removed. 

Matthew  Paris,1  the  historian,  in  his  description  of  eunuchs 
and  the  appearance  of  early  old  age,  tells  us  that  in  1253  Fred- 
erick II,  Emperor  of  Germany,  married  Isabella,  sister  of  the 
King  of  England,  and  he  presented  to  his  wife  several  Moorish 
slaves  who  were  eunuchs,  for  servants,  who  looked  like  old 
masks.  Pelikan2  also  mentions  that  the  whole  community  of 
castrated  Skopze  in  Russia,  has  a  withered  aspect;    and  in  his 

1  Quoted  after  Moebius,   "Die  Wirkungen  der  Castration,"   p.   43,   Halle, 
1907. 

2  Pelikan :      "Gerichlaeh  Med.   Untersuehenger   iiber   das   Skopzentham   in 
Russland,"  Giessen,  1876. 

(45) 


46  Old  Age  Deferred. 


book  Merschejewski  relates  that  their  skin  is  withered  and 
wrinkled,  and  that  they  look  worn  out,  aged,  and  senile. 

Besides  provoking  senility  at  an  early  period,  castration  or  a 
degenerated  condition  of  the  sexual  glands,  especially  in  women, 
is  able  to  produce  alterations  in  organs,  which  are  of  great  impor- 
tance to  the  vitality  of  individuals,  and  to  a  long  life,  such  as 
the  heart,  stomach,  intestines,  and  liver.  Experienced  authorities 
have  noted  heart  troubles  in  dysmenorrhea  and  amenorrhcea, 
and  also  neurosis  of  the  heart  with  long,  lasting  alterations  of 
the  female  sexual  glands.  Professor  Kisch3  also  noted  tachy- 
cardia in  such  conditions.  Professor  Landau4  has  very  often 
observed  a  degeneration  of  the  heart  after  myoma  of  the  uterus. 
Lehman  and  Strassmann,  in  the  Berlin  Charite,  have  seen  such 
a  degenerated  condition  of  the  heart  in  44  per  cent,  of  patients 
with  myomas  of  the  uterus. 

It  has  been  shown  by  experiments  that  there  is  a  close 
relation  between  the  condition  of  the  ovaries  and  the  heart. 
Professor  Hegar5  has  demonstrated  that  castration,  or  simple 
tugging  of  the  ovaries,  is  able  to  produce  a  diminution  of  the 
heart  beats,  or  even  a  stoppage  of  the  heart.  Lucas  Champion- 
niere  has  also  noted  the  same  after  a  tearing  of  the  ovaries,  and 
Mariagalli  and  Negri  have  also  noted  tachycardia  after  lapa- 
rotomy. 

Very  important  also  are  the  relations  between  the  ovaries 
and  the  digestive  organs.  Kretschy  observed,  in  a  case  of  fistula 
in  the  stomach,  that  alterations  of  the  female  sexual  organs 
regularly  produced  also  alterations  of  the  digestive  functions; 
for  instance,  during  menstruation  there  is  always  an  increased 
flow  of  hydrochloric  acid.  The  same  has  been  found  by 
Fleischer,  who  noted  during  this  period  a  sluggishness  in  diges- 
tion, which  improved  after  menstruation. 


3  Kisch:     "Das  Geschlestrlehen  der  Frau,"  second  edition,  Vienna,  1908. 

4  Quoted  after  Kisch. 

5  Quoted  after  Kisch ;    as  also  other  authors  on  the  relation  between  heart 
and  stomach,  and  the  ovaries. 


Sexual  Glands — Vitality  and  Long  Life.  47 

Tanecki  found  dyspeptic  troubles  in  cases  of  retroflexion 
of  the  uterus,  and  Eisenheart  has  observed  the  disappearance  of 
acute  gastric  troubles  after  a  cure  of  retroflexion. 

P.  Muller  also  declares  that  there  are  intimate  relations 
between  the  sexual  glands  and  the  digestive  organs.  He  also 
observed  dyspeptic  troubles  during  menstruation ;  and  Professor 
Leyden  has  noted  neuralgia  and  hyperesthesia  of  the  stomach 
in  young  girls  after  menstrual  troubles. 

Habitual  chronic  constipation,  which  is  so  frequent  after 
a  degenerated  condition  of  the  sexual  glands,  points  to  the  exist- 
ence of  close  relations  between  these  organs  and  the  intestines. 

Based  upon  clinical  observations,  we  have  advanced  the 
theory  that  alterations  of  the  ovaries  are  able  to  produce  altera- 
tions also  of  the  liver,  and  the  circulation  of  the  bile,  with  forma- 
tion of  gall-stones.  Castration  also  produces  alterations  of  the 
thyroid:  first,  its  hyperactivity  with  increase  of  colloid  sub- 
stance, and,  afterward,  its  degeneration. 

Castrated  animals  or  persons  seem  to  offer  less  resistance 
to  infection,  which  may  be  on  account  of  the  connection,  as 
shown  by  the  experiments  of  Metschnikoff6  and  others,  that 
the  testicles  are  altered  in  infections,  which  has  been  shown  to 
be  equally  the  case  with  the  ovaries  (Professor  Cornil).  The 
sexual  glands,  as  the  ductless  glands  in  general,  have  the  duty 
also  of  protecting  the  body  against  the  various  kinds  of  intoxi- 
cation and  infections,  as  already  emphasized. 

From  the  foregoing  there  can  be  no  doubt  that  degenerated 
conditions  of  the  sexual  glands,  by  producing  alterations  in 
important  organs,  diminish  vitality  and  the  chances  of  an 
advanced  old  age. 

This  seems  also  to  apply  to  males,  for  there  is  no  evidence 
showing  that  any  eunuch  has  reached  a  very  advanced  age, 
whereas  there  is  plenty  of  evidence  of  persons  with  strong  sexual 
glands  having  lived  far  beyond  ioo  years.  The  vitality  of 
persons  if  totally  castrated  is,  as  a  rule,  diminished. 

6  Metschnikoff :     Loc.  cit. 


48  Old  Age  Deferred. 


Again  if  we  study  the  history  of  persons  who  attained  the 
maximum  span  of  life,  we  find  many  evidences  of  the  existence 
of  strong  sexual  impulses.  Thomas  Parr,  who  lived  to  nearly 
153,  has  been  accused  of  having  committed  a  sexual  offense  in 
his  I02d  year,  for  which  he  was  found  guilty  and  punished. 
Reaching  even  a  greater  age,  his  sexual  appetite  does  not  seem 
to  have  diminished,  for  he  married,  eighteen  years  after,  a  widow, 
who  said  she  could  discover  nothing  that  would  betray  his  great 
age. 

Drakenberg,  a  Dane,  who  is  buried  in  the  cathedral  in 
Aarhus,  Denmark,  lived  146  years,  and  reached  this  advanced  age 
although  he  was  more  often  drunk  than  sober.  When  he 
was  in  he  married  a  woman  of  60,  and  after  she  died  he  fell 
in  love  in  his  130th  year  with  a  young  peasant  girl;  but  this 
blooming  flower  of  the  Jutland  peninsula,  famous  for  its  fresh 
and  healthy  girls,  refused  her  ancient  wooer,  who,  nothing 
daunted,  tried  his  luck  with  several  other  young  maidens  but 
with  no  better  success;  therefore  he  had  perforce  to  remain 
a  widower,  and  he  lived  an  additional  sixteen  years.  Possibly 
if  he  had  addressed  widows  or  elderly  spinsters,  he  might  have 
succeeded;  but  it  is  very  instructive  that  this  ancient  Methu- 
selah insisted  on  marrying  a  young  girl,  which  certainly  speaks 
in  favor  of  strong  sexual  feelings  in  so  old  a  man,  and,  indeed, 
we  may  say  it  is  an  object  lesson  to  us  to  observe  that  these 
ancients  were  always  anxious  to  marry  again  so  soon  as  they 
became  widowers.  That  it  was  more  than  a  mere  formality, 
or  bond  of  platonic  affection,  was  attested  to  by  Thomas  Parr's 
wife  when  he  was  in  his  130th  year. 

If  many  children  be  considered  a  sign  of  sexual  activity 
and  capacity,  these  very  old  men  distinguished  themselves  in 
this  respect,  as  most  of  them  had  numerous  progeny.  Several 
had  a  score  of  children  after  they  were  80.  Peter  Albrecht,  who 
lived  to  be  123,  married  in  his  85th  year,  and  had  7  children. 
Another  patriarch,  Gurgen  Douglas,  born  in  Marstrand,  near 
Gothenburg,  in  Sweden,  who  reached  to  120  years  and  7  months, 


Sexual  Glands — Vitality  and  Long  Life.  49 

married  in  his  85th  year  and  had  8  children,  one  of  which  was 
born  when  he  was  in  his  103rd  year.  This  child  was  an  idiot, 
but  as  it  is  very  interesting  to  note,  otherwise  physically  well 
developed. 

An  Italian,  Baron  Baravicino  de  Capellis,  died  in  1770  at 
Meran,  a  climatic  resort  in  the  Tyrol  (Austria),  in  his  107th 
year.  He  had  4  wives,  the  first  of  whom  he  married  when 
he  was  14,  and  the  last  when  he  was  84.  He  had  7  children, 
and  it  is  an  interesting  fact  that  his  wife  was  pregnant  when 
he  died. 

As  an  English  paper  has  reported,  in  1796  there  was  a 
shoemaker,  R.  Glan,  living  near  Philadelphia,  Pa.,  who  died 
at  114,  and  never  missed  a  Sunday  service.  At  his  decease  his 
third  wife  was  but  30,  and  his  virile  powers  were  normal. 

We  need  not  be  too  skeptical  as  to  the  legitimacy  of  the 
children  of  fathers  of  such  advanced  age  for  reasons  we  will 
mention  later.  Examples  of  fathers  at  ages  above  60  or  70 
are  not  so  exceedingly  rare.  A  very  good  example  of  this  is 
that  of  a  crowned  head  of  one  of  the  European  countries,  mar- 
ried morganatically,  who,  in  his  72nd  year,  was  presented  by 
his  wife  with  a  child,  and  nobody  who  is  acquainted  with  the 
powerful  constitution  of  this  monarch  and  his  predilection  for 
the  fair  sex  will  doubt  his  happiness  as  a  father.  He  is  noted 
for  his  marvelous  intellect,  which,  again,  is  so  frequently  met 
with  in  persons  with  very  active  sexual  glands. 

Several  of  these  ancient  patriarchs,  at  the  autopsy,  pre- 
sented a  wonderfully  good  state  of  preservation  of  the  various 
organs.  Thomas  Parr  died  in  his  153d  year,  and  his  autopsy 
was  made  by  one  of  the  greatest  physicians  in  the  history  of 
medicine — the  celebrated  Harvey,  the  discoverer  of  the  circulation 
of  the  blood.  Harvey  found  every  organ  in  this  wonderful  old 
man  in  perfect  condition.  His  death  was  attributed  by  Harvey 
to  over-eating,  as  Parr  had  always  lived  a  very  frugal  life.  The 
King  of  England  invited  this  astonishing  personage  to  London  in 
his  I52d  year,  as  he  wanted  to  know  this  most  interesting  of  his 


50  Old  Age  Deferred. 


subjects;  but  the  rich  food  he  received  in  the  royal  household 
did  not  prove  beneficial  to  him,  and  though  his  1 52  years  of  frugal 
life  were  unable  to  kill  him,  nine  months  of  an  opposite  style 
of  living  succeeded  in  so  doing. 

We  should  not  wish  to  omit  mentioning  again  the  impor- 
tant fact  that,  with  few  exceptions,  the  persons  who  lived  to 
such  an  extraordinary  age  were  married,  and  some  of  them 
three  or  four  times,  which  again  serves  to  show  us  the  great 
importance  of  marriage  as  a  means  to  reach  a  good,  old  age. 

We  have  quoted  these  instances  of  longevity  from  Hufe- 
land,7  one  of  the  greatest  German  physicians  of  the  eighteenth 
century,  of  whose  truthfulness  there  can  be  no  doubt.  The 
great  German  physiologist,  Pfliiger,  also  quoted  some  of  the 
above  examples  of  great  age  in  his  address  in  celebration  of  the 
birthday  of  Emperor  William  II,  at  the  University  of  Bonn. 
When  Parr  had  been  found  guilty  of  a  misdemeanor  in  his 
I02d  year  facts  were  adduced  in  the  courts  which  showed  that,  as 
Pfliiger  says,  this  "100  jahrige  durchaus  die  Eigenschaften  eines 
Kraftegen  jugendlichen  mannes  besass"  (the  man  of  100  years 
really  had  the  qualities  of  a  powerful  young  man).  Pfliiger 
quotes  this  from  Flourens,  and  we  were  pleased  to  find  an 
account  of  the  autopsy  of  the  celebrated  patriarch  in  a  letter 
from  Harvey,  himself,  to  his  nephew,  published  by  the  Syden- 
ham Society8 :  "The  body  was  in  such  a  good  condition  in  a 
man  of  153  that  the  cartilages  of  the  chest  bones  were  not  yet 
ossified."  Harvey  put  it :  "The  cartilages  were  soft  and  flexi- 
ble," black  hair  on  the  forearms,  and  the  organs  apparently 
healthy.  Probably  the  fact  that  the  testes,  as  Harvey  says,  "were 
sound  and  large,"  had  something  to  do  with  it.  He  was  also  an 
affectionate  husband,  and  to  quote  Harvey  again,  "His  wife  told 
me  that  until  twelve  years  ago  he  never  ceased  to  embrace  her 
frequently"  ;  that  is,  when  he  was  140  years  old !    At  the  autopsy 


7  Huf eland :     Loc.  cit. 

8  The  works  of  William  Harvey,  M.D.,  edition  of  the  Sydenham  Society, 
p.  590,  London,  1847. 


Sexual  Glands — Vitality  and  Long  Life.  51 

of  John  Bayley,  of  Northampton,  who  died  130  years  old,  Dr. 
James  Keill9  found  his  testes  of  large  size. 

We  have  also  knowledge  of  a  very  interesting  case,  that 
of  an  Irishman,  an  ex-navy  man,  who,  according  to  the  admiralty 
official  statistics,  was  113  years  old,  and  whose  body  was  dis- 
sected by  Professor  Cunningham,  Professor  of  Anatomy  of 
Edinburgh  University.  As  Dr.  Cunningham,  himself,  told  us, 
the  testes  were  sound  and  healthy  looking,  and  the  cartilages 
of  the  chest  bone  not  yet  ossified.  Death  was  not  due  to  old 
age,  but  to  a  prostate  abscess,  except  for  which  the  body  was  in 
good  condition. 

Metschnikoff  also  mentions  in  his  "Etudes  sur  la  Nature 
Humaine"  examples  of  old  men  between  94  and  104  years,  who 
suffered  from  copious  spermatorrhoea,  and  in  whose  semen  he  has 
found  a  great  quantity  of  spermatozoa.  He  and  Dr.  Weinberg 
observed  similar  conditions  in  old  dogs  of  18  to  22  years  of 
age,  one  of  whom,  just  before  his  death,  had  shown  marked 
sexual  tendencies.10  Saverio  Spangaro,11  examining  the  testicles 
of  a  number  of  old  men,  found  many  of  them  atrophied,  but 
others  showed  microscopically  no  difference  to  the  testicles  of 
younger  individuals ;  there  were  only  slight  microscopical 
changes.  This  again  proves  our  theory,  that  old  age  is  not  due 
to  the  degeneration  of  one,  but  of  several  glands  with  internal 
secretion,  similarly  to  other  diseases  of  these  glands,  like  dia- 
betes, acromegaly,  etc. 

The  above  facts  of  the  preservation  of  the  sexual  glands  in 
advanced  old  age,  proves  also  the  important  fact  that  though 
the  actual  age  be  there,  the  symptoms  of  it  may  not  be  very 
pronounced  if  but  the  sexual  glands  are  in  good  order.  Of 
course  the  condition  of  the  other  ductless  glands  is  of  impor- 
tance, for  old  age  must  be  regarded  as  the  consequence  of  the 
degeneration  of  the  different  ductless  glands,  and  not  of  one 
gland  alone. 


9  Philosoph.  Transactions,  xxv.,  1706. 
10  Essais  optimistes,  p.  47,  Paris,  1907. 
US.  Spangaro:     Anatomische,  Hefte,  Heft  lx.,  p.  630,  Wiesbaden,  1902. 


52  Old  Age  Deferred. 


When  we  consider  the  splendid  health  enjoyed  by  most  of 
these  patriarchs  and  the  good  condition  of  their  organs,  why 
should  we  deny  the  possibility  that  they  were  disposing  of  at 
least  one  lively  spermatozoon,  and  thus  we  shall  have  no  reason 
to  doubt  their  happiness  as  fathers. 

We  must  also  add  that  the  truth  of  the  extraordinary  age 
of  these  persons  has  been  proved,  in  most  cases,  by  documents, 
sometimes  even  in  courts  of  law ;  also  by  the  recollections  of 
very  old  people  who,  in  their  own  early  childhood,  personally 
knew  them. 

That  people  with  strong  sexual  impulses  very  often  reach 
a  very  advanced  old  age,  we  can  often  observe.  There  are 
plenty  of  examples  in  the  history  of  the  world.  Thus,  the 
greatest  debauchery  did  not  prevent  Louis  XV  becoming  very 
old,  and  the  Emperor  Tiberius  lived  to  be  78  after  his  notorious 
life.  However,  in  the  same  way  as  with  alcohol  and  tobacco, 
we  would  here  repeat  "Quod  licet  Jovi,  non  licet  bovi"  (or, 
"what  suits  Peter  may  not  suit  Paul"). 

We  may  also  refer  to  a  few  instances  coming  under  our 
own  observation.  A  few  years  ago  one  of  our  confreres  at 
Carlsbad  died,  96  years  of  age.  His  intellect  was  perfect,  and 
a  few  months  before  his  death  we  had  a  consultation  together 
about  a  patient  who  was  83,  at  which  he  gave  evidence  of  a 
wonderfully  clear  intelligence.  In  his  behavior  toward  the  fair 
sex  (whom  he  much  admired)  he  showed  a  chivalry  and  gal- 
lantry outvying  men  of  half  his  age.  Up  to  the  last  he  never 
failed  to  attend  a  theatrical  performance  when  there  was  an 
operetta  or  a  ballet.  There  was  nothing  to  prevent  his  attain- 
ing a  greater  age,  but,  falling  in  his  room,  he  contracted  a  frac^ 
ture  of  the  femur,  followed  by  pneumonia,  which  put  an  end  to 
his  medical  practice,  for  this  wonderful  old  man  in  his  advanced 
years  paid  his  daily  visits,  which  he  only  intended  to  cease,  as 
he  said,  when  he  reached  100. 

A  prominent  member  of  the  aristocracy  of  one  of  the  north- 
ern countries  of  Europe,  who  is  at  present  90  years  old,  hav- 


Sexual  Glands — Vitality  and  Long  Life.  53 

ing  been  reproached  several  years  ago  by  his  relatives  for  his 
amorous  advances  to  the  fair  sex,  gave  the  answer,  "You  do 
not  know  what  it  means  to  be  an  old  man  with  the  body  of  a 
young  man."  This  old  man  still  rides  on  horseback  and  still 
goes  shooting.  The  fact  that  he  looks  a  handsome  man  of  60 
may  be  explained  on  the  basis  of  our  above  observation. 

In  advanced  old  age  the  preservation  of  the  sentiments 
toward  the  opposite  sex,  which  allows  us  to  presume  the  pres- 
ence, and  not  yet  extinction,  of  an  internal  secretion  of  the  sex- 
ual glands,  is  often  found  in  combination  with  a  high  intellect. 
This  is  also  proved  by  the  example  of  Goethe  in  his  83d  year, 
for  in  his  old  age  his  intellect  would  have  been  creditable  to  a 
man  of  30.  When  he  was  over  81  he  astonished  his  audience 
by  the  uninterrupted  current  of  his  ideas,  also  the  extraordinary 
richness  of  his  inventions.12  Commenting  on  the  above,  Moebius, 
in  an  interesting  biography  on  Goethe,  says :  "From  the  physio- 
logical standpoint  the  astonishment  evoked  by  the  works  of  this 
old  man  is  almost  greater  than  that  about  his  juvenile  activity." 
He  finished  the  second  part  of  "Faust"  when  he  was  over  82. 
As  Metschnikofr  says:  "It  is  love  that  was  the  greatest  stimu- 
lant of  the  genius  of  Goethe,"  for  it  is  well  known  that  Goethe 
was  an  ardent  admirer  of  the  fair  sex.  When  he  was  74  he  was 
passionately  in  love  with  Ulricke  Lewetzow,  who  was  still  in  her 
teens.  He  danced  like  a  youth  when  in  her  company,  and  it 
was  at  this  time  that  he  wrote  to  his  son  that  he  had  never, 
up  to  this,  felt  so  well  in  mind  and  body.  He  wanted  to  marry 
the  young  girl,  and  the  Grand  Duke  of  Saxe- Weimar  asked  in 
Goethe's  name  for  her  hand;  but  the  mother  was  not  willing 
to  allow  a  marriage  between  persons  of  such  divergence  in  age. 
So  much  was  Goethe  in  love  with  the  young  girl  that  his  dis- 
appointment contributed  to  develop  a  serious  illness  (Ecker- 
mann).  Even  when  he  was  much  older  he  again  renewed  his 
relations  with  Miss  Marianne  Young,  and  was  then,  to  a  certain 
extent,  consoled  for  his  disappointment  over  Miss  Lewetzow. 
12  Eckermann :     Quoted  after  Metschnikoff. 


54  Old  Age  Deferred. 


He  preserved  his  admiration  for  the  fair  sex  until  his  death, 
and  even  in  the  closing  day  of  his  life  in  his  delirium  he  called 
out,  "Look  at  that  beautiful  woman's  head  with  dark  curls  on 
a  black  background!"13 

A  similar  retention  of  the  sexual  sense  we  see  in  the 
advanced  years  of  Victor  Hugo,  whose  admiration  of  the  oppo- 
site sex  continued  till  his  death.  Ibsen,  the  celebrated  Norwe- 
gian dramatist,  kept  up  a  well-known  correspondence  with  a 
young  lady  whom  he  met  at  Marienbad  a  short  time  before  he 
died  in  advanced  old  age. 

Sometimes  in  women  of  extreme  age  instances  are  quoted 
that  would  seem  to  indicate  that  in  them  also  the  activity  of  the 
sexual  glands  may  not  have  been  extinct.  It  is  stated  that 
Ninon  de  l'Enclos14  was  in  her  90th  year  still  so  beautiful  that 
a  young  abbe  fell  desperately  in  love  with  her.  We  know  an 
Italian  lady  of  69  who  is  still  good-looking,  presenting  the 
appearance  of  45,  and  she  still  menstruates.  That  she  was  sex- 
ually active  is  shown  by  the  fact  that  she  has  12  children.  There 
is  more  fire  in  the  eyes  of  this  Italian  matron  than  in  many 
women  of  half  her  age.  That  the  possession  of  active  sexual 
glands  influences  the  looks  very  much  can  also  be  proved  by 
the  pale,  yellow-gray  and  aged  looks  of  even  young  women 
suffering  from  serious  chronic  diseases  of  the  sexual  glands, 
and  also  of  women  who  have  caused  these  organs  to  degenerate 
owing  to  sexual  excesses. 

The  fact  that  persons  who  have  attained  advanced  old  age 
in  robust  health  and  perfect  intellect  often  show  signs  of  pre- 
servation of  the  sexual  glands,  permits  the  inference,  especially 
considering  the  foregoing  examples,  that  a  perfect  condition  of 
these  glands  is  an  important  factor  toward  vitality  and  long  life, 
for  which  reason  we  devote  a  long  chapter  to  the  best  hygiene 
of  the  sexual  glands  (see  Chapter  XLIX). 

13  Lewes :    Vol.  ii.,  p.  372 ;    quoted  from  Metschnikoff. 

14  Quoted  from  Professor  Kisch. 


CHAPTER  VI. 

On  Heredity  and  Longevity. 

We  occasionally  witness  the  peculiar  fact  that  persons 
who  live  very  moderately  and  eat  very  sparingly,  and  who  totally 
abstain  from  alcohol,  nevertheless  become  old  before  their  time, 
while,  on  the  other  hand,  there  are  those  who,  in  spite  of  having 
been  addicted  all  their  lives  to  the  pleasures  of  a  bounteous  table 
and  unstinted  quantity  of  wine  or  spirits,  yet  enjoy  a  green  old 
age.  We  had  an  opportunity  of  observing  an  old  gentleman  of 
76  (some  say  he  was  really  older)  belonging  to  our  own  pro- 
fession, with  whom  we  had  the  pleasure  of  traveling  from  Lis- 
bon to  Paris  in  the  same  small  railway  compartment.  This 
gentleman,  notwithstanding  his  age,  was  in  full  possession  of  all 
his  mental  powers,  of  which  he  has  given  remarkable  proofs 
in  his  recent  publications  which  might  have  well  been  written  by 
a  man  younger  by  some  scores  of  years,  and  which,  in  fact, 
convey  that  impression.  This  gentleman's  age  cannot  be  gauged 
by  his  words,  neither  was  it  shown  by  the  hearty  appetite  with 
which  he  partook  of  the  six  courses  of  the  dinner,  nor  by  the 
enjoyment  with  which  he  disposed  of  his  bottle  of  claret;  and  he 
smoked  a  large  cigar  afterward  with  such  appreciation  that  we 
began  to  envy  the  old  man.  We  almost  believe  that  he  stood 
the  long-continuous  journey  of  thirty-seven  hours  much  better 
than  we  did,  and  we  were  surprised  at  his  fresh  appearance  the 
following  morning  after  the  discomforts  of  a  night  in  a  small 
berth  of  the  Compagnie  Internationale  des  Wagons-lits,  half 
the  size  of  the  ordinary  American  Pullman  car  berth.  We  must 
remark,  however,  at  once,  that  such  instances  as  these  are  excep- 
tional. Nature  is  always  just,  and  even  here  we  have  an  illus- 
tration of  the  Golden  Rule,  for  such  persons  inherit  the  health 

of  their  fathers. 

(55) 


56  Old  Age  Deferred. 


Even  character  and  appearance  may  be  inherited  by  off- 
spring. The  height  of  parents  is,  as  a  rule,  though  not  in  every 
case,  inherited  by  their  children,  as  also  are  many  features  of 
their  external  appearance.  As  we  have  seen  in  the  previous 
chapter,  the  size  of  an  individual  and  his  outward  appearance 
are  dependent  on  the  internal  secretions  of  the  ductless  glands; 
and  as  these  qualities  are  inherited,  so  we  may  presume  that  the 
properties  of  the  ductless  glands,  which  produce  these  effects, 
may  also  be  inherited;  and  that  this  is  not  a  vague  supposition 
is  demonstrated,  we  think,  in  a  paper  we  read  on  the  subject 
of  heredity  at  the  German  Congress  of  Internal  Medicine  at 
Leipzig,  in  1907,  in  which  we  showed  that  the  alterations  of 
the  ductless  glands  are  inherited  with  remarkable  frequency. 
Thus  Graves's  disease  can  frequently  be  inherited,  and  the  chil- 
dren descended  from  such  parents,  especially  after  puberty, 
often  have  a  small  goiter.  In  such  cases  a  slight  protuberance  of 
the  eyes  can  also  be  noticed;  they  are  frequently  very  nervous, 
and  any  sudden  shock  will  be  sufficient  to  induce  a  typical  case 
of  Graves's  disease.  Oesterreicher1  found  9  cases  of  exophthal- 
mic goiter  in  one  family.  The  frequent  instances  of  heredity  in 
Graves's  disease  are  insisted  upon  by  Brouwer2  and  other  authors. 

Degenerative  changes  of  the  pituitary  body  may  also  be 
inherited.  Thus  Bonardi  and  Schwoner  and  others  also  showed 
cases  of  acromegaly  of  hereditary  origin. 

Diabetes  is,  as  we  have  said,  a  disease  of  the  ductless  glands, 
and  we  have  especially  emphasized,  on  previous  occasions,  how 
frequently,  if  not  invariably,  diabetes  originates  through  heredity. 
We  have  also  shown  in  a  communication  published  in  the 
Practitioner,  of  London,  in  October,  1903,  that  the  children  of 
diabetic  persons  have  an  inherited  tendency  to  alimentary  glyco- 
suria, which  occurs  very  frequently  among  them. 


1  Quoted   after   Moebius.   "Die   Basedow'sche   Krankheit,"    second  edition, 
1906. 

2  Quoted    after    Oppenheim,    "Lehrbuch    des    Nervenkrankheiten,"    Berlin, 
1906. 


Heredity  and  Longevity.  57 

Myxedematous  persons,  as  a  rule,  have  children  displaying 
symptoms  of  congenital  myxcedema,  and  cretins  have  cretinous 
children.  The  very  interesting  case  has  been  published  of  a 
woman  who,  until  the  age  of  40,  had  two  normal  children.  She 
then  acquired  a  goiter,  and  the  child  that  was  born  later  was  a 
cretin  with  a  goitef  (Lanz). 

Parents  suffering  from  diseases  in  which  the  thyroid  has 
degenerated,  such  as  chronic  tuberculosis,  malaria,  syphilis,  and 
other  cachectic  diseases,  have  children  whose  growth  is  slow, 
and  who  remain  backward  physically  and  mentally.  Such  chil- 
dren easily  acquire  any  infectious  disease.  Tuberculosis,  as  we 
have  shown  at  the  International  Congress  on  Tuberculosis  in 
Paris,  in  1905,  is  remarkably  frequent  among  them.  We  can 
easily  appreciate  the  fact,  if  we  realize  that  the  children  of  such 
parents  in  whom  the  thyroid  has  degenerated  through  disease  are 
born  usually  with  a  congenital  atrophy  of  the  thyroid  gland,  which 
has  been  proved  by  Gamier  and  Perrando.  These  children  have 
inherited  from  their  forefathers  the  bad  qualities  of  their  thy- 
roid, and  this  will  also  explain  why  such  children,  when  fully 
grown  up,  will  not  remain,  as  a  rule,  for  so  long  a  time  as  youth- 
ful looking  as  other  persons  who  have  inherited  healthy  thy- 
roids ;  they  early  become  aged-looking  and,  also,  as  a  rule,  their 
lives  are  shortened  owing  to  their  tendency  to  contract  easily  all 
kinds  of  infections. 

Evidence  founded  on  experiments  is  at  our  disposal  to 
prove  our  assertion  that  irregularities  of  the  thyroid  are  inherited 
by  offspring.  Professor  Lanz,3  of  Amsterdam,  formerly  an 
assistant  of  Professor  Kocher  in  Bern,  has  extirpated  the  thy- 
roid gland  of  goats,  and  he  found  that  in  each  case  the  young 
of  such  animals,  as  compared  with  normal  kids  of  the  same 
age,  remained  backward  in  growth.  There  can  thus  be  no  doubt 
that  the  qualities  of  the  ductless  glands  of  the  parents  are  in- 
herited by  their  descendants. 


3  Beitrage  zur  klin.  Chirurgie,  xiv.,  p.  1,  1905. 


58  Old  Age  Deferred. 


We  often  find  diseases  of  the  various  ductless  glands 
present  among  members  of  the  same  families.  We  can  trace, 
not  infrequently,  diabetes,  Graves's  disease,  etc.,  and  acromegaly, 
occurring  in  different  members  of  the  same  family,  and  this 
will  be  observed  most  often  in  the  case  of  diabetes  and  Graves's 
disease.  Thus  I  have  observed  in  the  case  of* two  fathers  (com- 
ing from  the  same  city  in  Hungary,  but  belonging  to  different 
nationalities)  diabetes,  and  their  daughters  had  protuberant  eyes; 
they  had  a  small  goiter,  and  the  typical  fingers  characteristic  of 
Graves's  disease,  emaciated  and  pointed  like  those  of  the 
Madonna  of  Perugino,  which  have  been  mentioned  already  by 
other  authors  as  symptoms  of  Graves's  disease.  There  was  no 
tachycardia  as  yet  in  either  of  these  two  cases  which  had  Graves's 
disease.  Very  probably  any  mental  shock,  as  in  so  many  other 
cases,  would  here  have  caused  sudden  development  into  Graves's 
disease. 

We  have  already  noted  that  in  syphilis  and  other  cachectic 
diseases  such  as  alcoholism,  malaria,  tuberculosis,  etc.,  the  thy- 
roid gland  becomes  degenerated  (Gamier,  Hertoghe,  etc.),  and 
that  the  foetuses  of  such  parents  demonstrate  congenital  atrophy 
of  the  thyroid  (Gamier4  and  Perrando5).  We  can  thus  under- 
stand the  observations  of  Hertoghe,  who  found  that  nearly  all 
cases  of  infantile  or  congenital  myxcedema  were  born  of  parents 
suffering  from  the  above-named  diseases.  Of  very  great  value, 
also,  is  the  observation  of  Professor  Pel.6  He  diagnosed  a  case 
of  syphilis  in  the  father,  myxcedema  in  the  daughter  and 
acromegaly  in  the  son. 

As  shown  by  many  observers,  including  ourself,  the  duct- 
less glands  stand  together  in  a  very  close  relationship,  and  thus  we 
may  find  that  when  one  member  of  a  family  shows  an  alteration 
of  the  ductless  glands,  we  may  discover  in  the  same  family  other 
members  affected  by  alterations  of  the  same  or  other  ductless 


4  Gamier:     "Les  maladies  infectieuses,"  These  de  Paris,  1899. 

5  Perrando:     "Sulla  struttura  della  Tiroide,"  Sassari,  1900. 
6 Pel:     Berl.  klin.  Wochenschrift,  44%  1905. 


Heredity  and  Longeznty.  59 

glands.  The  case  of  Pel  is  a  fine  illustration  of  this  point;  the 
syphilis  of  the  father  with  its  morbid  influence  on  his  thyroid 
resulting  in  the  hereditary  transmission  of  a  degenerated  thyroid 
to  the  daughter,  and  the  consequent  supervention  of  myxcedema. 
The  son  had  an  altered  condition  of  the  pituitary  body,  and 
thus  developed  acromegaly.  The  altered  condition  of  the 
pituitary  body  may  have  been  secondary  to  the  previous  altera- 
tion of  the  thyroid  inherited  congenitally,  if  we  take  into  con- 
sideration the  fact  that,  as  I  showed  in  a  communication  to  the 
International  Congress  of  Medicine  in  Madrid,  in  1903,  acro- 
megaly is  due  to  primary  alterations  in  the  thyroid  which,  in 
the  same  way  as  is  demonstrated  by  experiments  on  animals, 
may  lead  secondarily  to  alterations  of  the  pituitary  closely  con- 
nected with  the  former  gland.  The  qualities  of  the  sexual  glands 
can  also  be  inherited.  Thus,  there  are  cases  of  mothers  whose 
menstruation  began  very  early,  i.e.,  at  the  age  of  9  or  10,  and 
lasted  until  the  age  of  56  to  60,  and  who  had  many  children, 
among  whom  were  daughters  showing  similar  conditions.  On 
the  other  hand,  we  may  see  difficulties  of  menstruation  in  the 
mother  also  inherited  by  the  daughter. 

If  the  bad  qualities  of  the  ductless  glands  are  inherited, 
it  is  only  logical  to  expect  the  same  for  the  good  qualities  also. 
It  stands  on  this  basis  that  we  may  frequently  find  longevity  in 
the  same  family.  Longevity,  as  illustrated  by  the  many  facts 
adduced  in  this  book  from  the  field  of  clinical  and  experi- 
mental observations,  is  closely  allied  with  a  thorough  perform- 
ance of  the  functions  of  the  ductless  glands,  especially  of  the 
thyroid  gland ;  if  these  are  in  good  condition,  and  especially  if 
proper  hygiene  is  also  observed  at  the  same  time,  longevity  will 
follow.  The  good  condition  of  the  ductless  glands  is  largely 
dependent  upon  a  life  based  on  hygienic  principles,  although 
when  these  glands  are  of  the  best  quality  they  may  stand  a  good 
deal  and  not  degenerate  so  soon,  even  after  excessive  activity 
following  injudicious  or  fast  living. 

But  if  a  long  life  be  dependent  on  a  good  state  of  the  duct- 


60  Old  Age  Deferred. 


less  glands  and  if  the  qualities  of  these  are  inherited — which 
cannot  be  doubted  after  the  foregoing  observations  on  heredity, — 
it  must  necessarily  follow  that  longevity  is  inherited  too,  and 
this  is  a  fact  which  can  be  proved  by  a  large  number  of  observa- 
tions. 

If  we  study  the  history  of  persons  who  have  lived  over  ioo 
years,  we  shall  find  in  nearly  every  case  that  their  forefathers, 
or  their  descendants,  or  other  relatives  of  the  same  blood  have, 
as  a  rule,  also  lived  to  a  great  age.  This  will  be  illustrated  by  a 
few  examples  which  we  will  now  give. 

In  the  year  1724  there  died  in  Hungary  in  a  village  called 
Kopros,  about  ten  miles  from  Temesvar,  a  man,  Petraz  Czarten, 
who  was  185  years  of  age.     When  he  died,  his  son  was  95. 

We  have  already  referred  to  the  case  of  a  man  named 
Thomas  Parr  in  our  chapter  on  the  influence  of  the  sexual  glands 
upon  vitality  and  long  life.  This  man  died  in  1635  in  his  153d 
year,  and  after  death  his  body  was  dissected  by  the  great  physician 
Harvey.  That  longevity  had  existed  in  his  family  was  shown 
by  the  fact  that  one  of  his  female  descendents  died  in  Cork,  in 
Ireland,  at  the  age  of  103. 

In  the  year  1797,  in  a  village  near  Bergen,  there  died  a 
man,  Joseph  Surrington,  in  his  160th  year.  That  he  left  a 
young  widow,  after  having  been  married  several  times,  is  not 
so  extraordinary  if  we  consider  the  facts  in  the  chapter  in  this 
book  on  the  influence  of  the  sexual  glands  upon  vitality  and 
long  life.  When  this  man  died  his  eldest  son  was  103  and  his 
youngest  only  9! 

In  a  Finnish  village  near  St.  Petersburg  there  lived  an  old 
peasant  woman,  Maria  Willamow.  She  was  born  in  1692,  and 
died  on  September  10,  1807,  after  having  lived  115  years,  9 
months,  and  4  days;  her  brother  had  already  died  in  1768  at  the 
age  of  108.  All  her  relatives  and  descendants  were  remarkable 
for  their  longevity. 

Jean  Thuret  was  a  soldier,  and  in  spite  of  having  been 
wounded  in  several  battles,  he  lived  beyond  the  age  of   104. 


Heredity  and  Longevity.  61 

His  mother  died  when  118  and  his  uncle  at  130.  The  high  old 
age  of  many  of  these  patriarchs  is  proved  by  legal  evidence. 
Thus,  H.  Jenkins,  from  Yorkshire,  has  appeared  before  a  court 
of  justice  as  witness  in  a  matter  that  happened  140  years  ago. 
He  was  accompanied  by  two  sons,  of  whom  one  had  reached 
100  and  the  other  102  years.  Again,  conclusive  proof  of  the 
inheritance  of  long  life.7 

To  the  history  of  these  patriarchs  I  can  add  a  few  personal 
observations.  My  mother's  father  lived  to  the  age  of  104.  He 
never  smoked  and  could  read  without  spectacles  all  his  life.  He 
had  eleven  children,  of  whom  one  (an  aunt  of  mine)  is  95,  and  I 
have  every  reason  for  believing  that  she  will  continue  to  live  yet 
many  years  in  her  present  condition.  Another  daughter  is  at 
present  85 ;  a  son  is  83,  and  another  78. 

We  are  acquainted  with  the  history  of  the  family  of  a  phy- 
sician in  Amsterdam,  in  which  the  great  grandfather  was  96.  He 
had  six  sons  who,  between  them,  totaled  600  years,  one  of  them 
living  to  the  age  of  102,  some  of  the  others  to  80  and  90;  and 
there  is  a  daughter  79  years  of  age. 

From  the  foregoing  it  seems  that  persons  descended  from 
long-lived  families  have  themselves  a  good  chance  of  living  to 
a  great  age ;  but  to  do  this  it  is  essential  that  they  should  observe 
the  rules  of  hygiene  to  prevent  the  deterioration  of  their  duct- 
less glands. 

That  the  observance  of  good  hygiene  is  of  the  greatest 
importance  to  attain  longevity  can  be  best  adduced  by  the  fact 
that  persons  descended  from  short-lived  parents  may  also  attain 
a  green  old  age  in  robust  health,  as  I  will  show  by  a  few  exam- 
ples which  have  come  under  my  personal  observation. 

Sir  Herman  Weber,  the  author  of  a  valuable  work  on  the 
prolongation  of  life,  is  descended  from  parents  who  both  died 
at  an  early  age.  This  savant  has  himself  followed  the  excellent 
advice  he  gives  in  his  books  on  long  life,  with  what  result  can 


7  Quoted  after  Professor  Pel. 


62  Old  Age  Deferred. 


be  best  judged  by  his. healthy  and  vigorous  looks.  His  appear- 
ance is  that  of  a  man  many  years  his  junior,  yet  Sir  Herman 
was  82  a  few  years  ago  when  we  were  together  climbing  a  very 
steep  and  high  hill  in  Carlsbad.  When  we  arrived  at  the  sum- 
mit nothing  could  restrain  Sir  Herman,  but  he  insisted  on  also 
mounting  a  lofty  tower  to  see  the  surrounding  mountains,  with- 
out taking  any  rest  between  his  exertions,  and  this  in  spite  of 
the  warmth  of  the  weather. 

On  the  day  that  we  began  to  pen  these  lines  we  were  con- 
gratulating one  of  the  multifarious  professors  of  the  medical 
faculty  of  Berlin  on  his  73d  birthday.  He  is  in  perfect  and 
robust  health,  and  is  at  present  engaged  on  the  third  edition  of 
his  work,  which  is  well  known  in  medical  circles  all  over  the 
world.  He  told  us  his  father  was  33  and  his  mother  48  when 
they  died,  and  several  of  his  brothers  died  before  reaching  old 
age.  However,  his  grandfather  lived  to  be  90.  This  savant 
has  always  led  a  sober  and  regular  life. 

Sometimes  chronic  diseases,  like  syphilis,  etc.,  do  not  prevent 
people  who  come  from  a  long-lived  family  from  attaining  to  a 
very  old  age.  Thus  a  patient  of  mine,  a  French  gentleman  of 
72  years,  who  still  shows  symptoms  of  the  tertiary  form  of 
syphilis  acquired  fifty-two  years  ago,  is  still  looking  in  splendid 
health,  like  a  man  of  60,  and  was  complaining  to  me  about  his  too 
strong  sexual  feelings.  Likewise,  the  father  of  a  patient  of  mine 
has  reached  his  96th  year  in  spite  of  his  syphilis,  which  he  acquired 
an  age  ago. 

If  we  now  consider  the  environments  where  the  longest- 
lived  persons  are  found,  we  shall  find  that  those  who  always  live 
in  the  open  air,  and  also  moderately,  rising  early  in  the  morning 
and  leading  day  by  day  the  same  regular  life,  have  attained  the 
longest  lives.  A  great  number  of  long-lived  patriarchs  can  be 
found  among  the  peasants,  or  at  least  among  persons  living  in 
the  country  and  out  in  the  fresh  air  all  day.  Undoubtedly  the 
greatest  number  of  long-lived  people  are  to  be  found  in  the 
British    Islands,    especially    in    Scotland.      The   inhabitants    of 


Heredity  and  Longevity.  63 

Great  Britain  are  well  known  to  appreciate  fresh  air,  and  on  the 
Continent  we  often  see  them,  especially  Scotchmen,  going  about 
without  any  overcoat  even  on  a  cold  winter's  day. 

We  shall  see  in  various  chapters  of  this  book  how  essen- 
tially important  is  a  sound  hygiene  to  ensure  long  life,  and  we 
shall  demonstrate  in  separate  chapters  the  great  importance  of 
fresh  air  and  of  exercise  in  the  open  air. 

If  we  would  inquire  where,  are  to  be  found  the  greatest 
number  of  persons  over  ioo  years  of  age,  the  palm  must  be 
given  to  Bulgaria,  if  what  is  claimed  be  true,  vis.,  that  there  are 
3800  persons  over  that  age,  and  all  these  folk  partake  daily  of 
"jogurth,"  a  sour  milk  containing  three  different  microbes,  the 
most  efficacious  among  them  being  the  maeja  bacillus.  In  Ger- 
many, with  its  61,000,000  of  inhabitants,  there  are  but  71  per- 
sons over  100  years  old,  while  Bulgaria,  with  only  7,000,000, 
claims  to  have  3800,  and  that  it  is  due  to  the  jogurth  eaten 
every  day.  We  will  deal  more  fully  with  jogurth  in  the  chapter 
on  the  elimination  of  toxic  products  from  the  intestines. 


CHAPTER  VII. 

On   Means  which   can   Help  us   to   Determine  the 
Probable  Duration  of  Life. 

We  have  seen  in  the  first  chapter  of  this  book  that  we  may 
find  the  symptoms  of  old  age,  in  quite  early  years,  in  persons 
whose  ductless  glands  (the  thyroid,  ovaries,  testicles,  liver,  kid- 
neys, pancreas,  adrenals,  pituitary  body)  are  degenerated  by 
disease;  nervous  affections;  alterations  of  the  mind:  grief,  sor- 
row, etc. ;  chronic  infections ;  numerous  pregnancies,  etc.,  or  by 
faulty  hygienics :  excesses  in  food,  alcohol,  sexual  pleasures,  etc. 
We  have  also  seen  in  the  third  chapter  that  the  immunity  of  an 
individual  against  infections — be  it  by  bacterial  invasion  or  by 
poisonous  food  or  drugs,  etc. — is  dependent  upon  the  correct 
functionating  condition  of  these  glands.  We  have  seen  that 
those  in  whom  these  glands  are  degenerated  fall  easy  victims  to 
all  manner  of  infections,  and  the  previous  chapter  on  heredity 
shows  that  the  same  happens  to  children,  the  offspring  of 
parents  suffering  from  alcoholism,  tuberculosis,  or  malaria,  as 
the  children  of  these  parents  are  born  with  a  congenital  degen- 
eration of  the  thyroid,  and  thus  remain  backward  in  growth, 
both  mentally  and  physically,  and,  especially,  fall  easy  victims 
to  tuberculosis.  Their  life  is  generally  short.  While  such 
a  sad  cloud  hangs  over  the  head  of  persons  whose  glands  are 
damaged,  either  congenitally  or  by  disease,  much  more  favor- 
able is  the  lot  of  those  who  have  inherited  healthy  glands  and 
by  careful  living  have  preserved  them  intact,  or  who,  though 
born  with  ductless  glands  not  entirely  normal,  and  possibly  bor- 
dering on  a  condition  of  congenital  myxcedema,  have,  by  suit- 
able treatment  and  hygiene,  succeeded  in  improving  the  con- 
dition of  their  glands. 
(64) 


How  to  Determine  the  Probable  Duration  of  Life.         65 

We  have  seen  that  the  thyroid  influences  powerfully  the 
production  of  those  safeguards  of  our  body  against  infections — 
the  anti-bodies  being,  as  shown  by  Prof.  Sajous  (1903-1907), 
beyond  a  doubt  products  of  ductless  glands — and  the  better  the 
condition  of  the  glands,  the  more  protective  substances  will  be 
produced  in  order  to  fight  down  the  murderous  microbes,  or 
organic  poisons,  which  continually  threaten  us  with  destruction. 
In  this  fight,  a  person  with  healthy  ductless  glands  will  always 
attain  a  longer  life  than  one  with  ductless  glands  of  inferior 
quality.  The  better  the  condition  of  the  thyroid  the  greater  will 
be  the  activity  of  those  organs  that  are  under  its  direct  command 
{e.g.,  the  kidneys,  liver,  skin,  and  intestines),  and  by  the  increased 
activity  of  the  main  emunctories  of  the  body  poisonous  products 
will  be  eliminated  by  means  of  a  greater  flow  of  urine,  an  abun- 
dant perspiration,  and  thorough  purging.  Also  the  myriads  of 
toxic  products  that  are  brought  from  the  intestine  to  the  liver  will 
be  promptly  destroyed,  or  transformed  into  less  dangerous  com- 
binations. 

Thus  there  can  be  no  doubt  that  a  person  with  healthy 
ductless  glands,  especially  the  thyroid  and  testicles  or  ovaries, 
will  live  long  provided,  of  course,  no  other  vital  organ  be 
irreparably  diseased. 

The  question  now  arises,  by  what  means  can  we  ascertain 
whether  the  ductless  glands  are  in  good  condition  or  not?  We 
will  now  try  to  answer  this  important  question. 

We  can  diagnose  a  healthy  condition  of  the  ductless  glands 
either  directly,  by  the  examination  of  those  glands  which  are 
available  for  a  digital  examination,  as  the  thyroid,  sexual  glands 
or  liver,  or  indirectly,  by  the  examination  of  the  state  of  those 
functions  which  are  governed  by  these  glands;  e.g.,  the  heart's 
action,  the  pulse,  regulation  of  temperature,  defalcation,  diu- 
resis, digestion,  activity  of  the  skin  and  its  glands,  condition 
of  the  nervous  system,  etc. 

Before  entering  upon  the  examination  of  these  glands  we 
must  first  ascertain  whether  our  patient  comes  of  a  long-lived 


66  Old  Age  Deferred. 


stock,  or,  if  not,  whether  diseases  that  are  particularly  harmful 
to  the  ductless  gland,  and  are  commonly  hereditary,  like  tuber- 
culosis and  syphilis,  have  occurred  in  the  family.  According  to 
our  observation  boys  more  frequently  look  like  their  mothers, 
and  girls  like  their  fathers,  and  also  inherit  their  qualities.  After 
having  ascertained  the  family  history,  we  must  inquire  whether 
the  patient  has  had  any  diseases  that  are  specially  harmful  to 
the  ductless  glands:  e.g.,  infectious  diseases — scarlet  fever, 
diphtheria,  typhoid,  etc. — and  also  ascertain  his  usual  diet  and 
habits,  keeping  in  mind  the  bad  effects  of  abundant  meat  food 
upon  the  thyroid,  as  well  as  of  certain  stimulants  like  alcohol 
and  tobacco.  As  these,  if  of  bad  quality  and  taken  in  quantity 
for  a  long  time,  have  the  most  damaging  influence  on  the  duct- 
less glands,  our  prognosis  of  a  long  life  will  be  duly  influenced, 
and  in  particular  unfavorably  for  those  who  come  of  a  short-lived 
stock,  or  who  have  been  weakened  by  previous  infectious  dis- 
eases. If  some  persons,  otherwise  healthy  and  of  good  family 
history,  can  with  impunity  indulge  till  old  age  in  wine  and 
tobacco,  yet  this  is  not  a  general  rule.  Individuals  are  known  who 
drank  and  smoked  till  over  one  hundred  years  of  age,  but  such 
cases  are  rare,  and  we  may  quote  the  Latin  proverb :  "Quod  licet 
Jovi,  non  licet  bovi."  Everybody  will  admit  that  the  expectation 
of  life  in  those  who  are  moderate  in  the  use  of  wine  and  tobacco 
and  also,  let  us  insist,  of  tea  and  coffee,  is  much  greater  than 
in  the  immoderate.  We  will  further  deal  with  this  question  in 
our  chapters  on  alcohol  and  tobacco. 

After  having  given  an  exhaustive  history  of  the  persons 
whose  probable  lifetime  we  are  trying  to  determine,  we  next 
proceed  to  the  examination  of  those  ductless  glands  which  are 
available  for  direct  examination,  and  first  of  all,  the  thyroid. 

The  examination  of  the  thyroid  gland  by  palpation  is  a 
very  difficult  undertaking  and  necessitates  a  thorough  knowl- 
edge of  the  anatomy  and  physiology  of  the  gland.  We  must 
bear  in  mind  the  fact  that,  in  men,  we  generally  find  only  two 
lobes,  the  lateral  ones,  which  lie  on  either  side  of  the  trachea, 


How  to  Determine  the  Probable  Duration  of  Life.         67 

• 
as  the  median  lobe  is  generally  undeveloped  in  the  male.      I  he 

right  lobe  is  usually  larger  than  the  left.  In  women  the  median 
lobe  is  often  well  developed  and  can  be  distinctly  seen  in  enlarge- 
ment of  the  gland,  for  instance,  during  puberty,  menstruation, 
pregnancy,  etc.,  and  especially  when  a  goiter  exists  which,  for 
reasons  we  have  mentioned  previously,  is  more  common  in  the 
female. 

When  the  thyroid  shows  a  considerable  swelling,  as  in 
goiter,  it  can  be  seen  and  felt  easily,  but  not  always,  for  cases 
certainly  exist  where  in  life  no  thyroid  could  be  felt,  and  yet 
at  the  autopsy  a  large  goiter  has  been  found.  Thus,  in  a  case 
of  acromegaly  a  thyroid  of  about  130  grammes  was  found  by 
Holsti,1  though  during  life  nothing  could  be  discovered  by  pal- 
pation. When  a  large  thyroid  can  be  seen  and  felt,  we  are 
justified  in  diagnosing  a  swelling  of  the  gland;  but  in  cases 
where  we  neither  see  nor  feel  it,  we  are  not  always  justified 
in  stating  that  it  is  not  enlarged. 

When  palpating  the  thyroid  we  must  note  whether  it  is 
soft  or  hard.  If  soft,  the  tissue  present  is  probably  parenchy- 
matous in  nature  and  so,  probably,  entirely  secreting  tissue,  while 
a  goiter  that  feels  hard  may  denote  excess  of  connective  tissue, 
and  thus,  apparently,  an  inactive  gland.  The  presence  of  cystic 
formations  raises  the  possibility  of  a  large  quantity  of  colloid 
substance,  either  healthy  or  degenerate. 

Thus,  inspection  and  palpation  of  the  thyroid  can  give  us, 
to  a  certain  extent,  valuable  information;  we  must,  however, 
not  rely  entirely  upon  the  results  of  this  external  examination 
but,  especially  in  cases  where  no  thyroid  can  be  felt,  we  must 
add  to  the  external  examination  an  inquiry  into  the  condition 
of  those  functions  which'  are  governed  by  the  thyroid — we 
must,  in  fact,  examine  the  condition  of  those  organs  whose 
function  is  dependent  upon  the  internal  secretion  of  the  thyroid. 

Thus,  we  must  examine  the  skin  and  note  whether  it  is  dry 
or  moist,  and  whether  the  sweat  glands  are  acting  normally. 

1  Holsti:     Zeitschrift  fur  klin.  Medicin,  p.  272,  1892. 


68  Old  Age  Deferred. 


A  dry  skin,  with  diminished  perspiration,  denotes  an  inactive 
thyroid,  especially  when  excess  of  subcutaneous  fat  is  present. 
Excess  of  fat,  of  the  consistence  of  bacon,  is  characteristic  of 
a  greater  degeneration  of  the  thyroid — i.e.,  myxcedema, — and 
indicates  a  great  loss  of  function  of  the  thyroid  gland.  Pallor  of 
the  face,  with  round  red  patches  on  the  cheeks,  and  dilated  capil- 
laries, are  also  characteristic  signs  of  such  a  condition  in  its  early 
stages,  and  so  are  a  wrinkled  forehead,  especially  with  two  per- 
pendicular folds,  and  puffy  eyelids.  Wrinkling  of  the  skin  of  the 
hands,  taken  in  conjunction  with  other  signs,  is  also  a  point  of 
diagnostic  value. 

The  condition  of  the  musculature  can  also  give  us  some 
valuable  information.  The  thyroid  and  other  ductless  glands, 
as  the  sexual  glands,  govern  the  tonicity  of  all  the  muscles. 
In  children,  especially  about  the  age  of  puberty,  the  muscles 
are  firm  and  elastic,  but  in  later  years,  or  even  in  young  women, 
consequent  upon  various  conditions  which  are  harmful  to  the 
ductless  glands,  such  as  sexual  excesses  or  numerous  pregnan- 
cies, the  muscles  lose  their  tonicity  and  become  lax  and  flabby. 
This  also  occurs  in  myxcedema  arising  from  other  causes.  The 
viscera,  deprived  of  their  muscular  support,  become  displaced, 
and  in  this  way  arise  the  various  forms  of  visceroptosis. 

Premature  grayness  is  an  indication  of  probable  changes  in 
the  thyroid.  This  is  confirmed  by  the  fact  that,  as  a  rule,  such 
persons  are  also  very  nervous.  Premature  grayness  constitutes 
a  typical  symptom  of  myxcedema  and  hypothyroidia,  and  as 
such  has  been  described  already  by  Hertoghe.2  Falling  out  of 
the  hair  is  also  a  symptom  of  importance,  if  it  appears  in  early 
years,  especially  if  it  is  accompanied  by  falling  out  of  the  eye- 
brows and  the  hair  on  the  back  of  the  head.  On  the  other  hand, 
Sajous  found  that  in  appropriate  cases,  thyroid  extract  promotes 
the  growth  of  hair,  while  adrenal  extract  encourages,  besides,  the 
growth  of  the  eye-brows. 

In  examining  the  circulatory  system  we  must  bear  in  mind 


2Nouvelle:    Iconographie  de  la  Salpetriere,  Juillet-Aout,  1899. 


How  to  Determine  the  Probable  Duration  of  Life.         69 

the  powerful  influence  of  the  ductless  glands  upon  the  circula- 
tion, especially  that  of  the  adrenals,  thyroid,  and  pituitary  body. 
As  shown  by  Oliver  and  Schafer,  the  thyroid  secretion  dimin- 
ishes blood-pressure,  whereas  the  adrenal  secretion  increases  it. 
Thus,  these  two  glands  are  antagonistic  and  it  can  easily  be 
understood  that  if  there  is  not  sufficient  thyroid  secretion  to 
counterbalance  that  of  the  adrenals,  the  blood-pressure  will  in- 
crease. If  this  lasts  for  some  length  of  time,  very  serious  effects 
will  follow.  Atheroma  and  arteriosclerosis  may  ensue,  both  of 
which  conditions  tend  to  shorten  life.  The  adrenals  can  be 
stimulated  to  such  over-secretion  by  mental  emotions,  which  act 
upon  the  sympathetic  (splanchnic)  nerves.  Besides  mental 
emotion  they  can  also  be  stimulated  by  various  poisons,  such  as 
alcohol,  tobacco,  or  infectious  diseases  (see  Chapter  III).  We 
must  keep  these  facts  in  mind  when  we  examine  the  circulatory 
system,  and  we  must  ascertain  the  condition  of  the  arteries, 
whether  soft  or  hard,  and  of  the  blood-pressure.  Tortuosity  of 
the  temporal  artery  in  young  persons  is  also  a  sign  of  some  value. 
The  condition  of  the  coronary  arteries  is  of  the  utmost  impor- 
tance. We  must  also  not  forget  the  fact,  that  even  in  severe 
cases  of  arteriosclerosis  the  pulse  may  be  found  soft.  Every- 
thing will  depend  upon  the  examination  of  the  heart,  and  special 
attention  must  be  paid  to  the  second  sound  at  the  aortic  orifice, 
and  to  any  accentuation  of  that  sound. 

In  the  examination  of  the  digestive  organs  we  must  pay 
special  attention  to  the  state  of  the  appetite.  Very  often  with 
a  degenerated  thyroid  this  may  be  wanting.  The  appetite,  as 
shown  by  Pawlow,  is  under  the  influence  of  the  mind  as  we 
will  see.  With  a  sad  melancholic  disposition,  as  is  often 
found  in  persons  with  a  degenerated  thyroid,  there  is  insuffi- 
cient or  no  secretion  of  gastric  juice.  Besides,  in  myxedema- 
tous conditions  all  glandular  secretions  are  more  or  less  checked. 
Thus  food  passes  into  a  stomach  with  insufficient  gastric  juice, 
remains  there  in  stagnation  and  causes  fermentation.  The  stom- 
ach makes  vain  efforts  to  drive  the  food  into  the  intestine. 


70  Old  Age  Deferred. 


Slowly  an  atonic  condition  of  the  gastric  walls  arises,  and  later 
dilatation  of  this  organ.  The  fermenting  foodstuffs  in  the 
stomach  set  up  a  chronic  intoxication  of  the  organism. 

Concerning  the  condition  of  the  intestines  we  should  con- 
sider the  chances  of  long  life  greater  in  those  persons  whose 
bowels  act  regularly  and  who  are  never  constipated.  Such  per- 
sons are  able  to  eliminate  toxic  products  much  better  than  those 
who  are  suffering  from  chronic  constipation.  The  function  of 
the  intestines  is  powerfully  influenced  by  the  thyroid  gland, 
chronic  constipation  being  a  typical  symptom  of  all  conditions 
in  which  this  gland  is  degenerated,  whereas  in  the  opposite 
conditions,  such  as  Graves's  disease  (exophthalmic  goiter), 
diarrhoea  is  common.  By  giving  thyroid  gland  we  can  treat 
successfully  those  obstinate  cases  of  constipation,  which  are 
based  etiologically  on  such  grounds.  Besides  the  thyroid  gland, 
the  ovaries  also  influence,  to  a  large  extent,  the  intestines,  con- 
stipation occurring,  as  a  rule,  in  diseased  conditions  of  the 
female  sexual  organs. 

Flatulency  and  distention  of  the  bowels  are  very  frequently 
met  with  in  women  with  diseased  thyroids  or  ovaries,  and  are 
due  to  an  irritated  condition  of  the  nerves  of  the  intestines. 

When  examining  the  nervous  system  we  must  inquire  for 
headaches,  especially  in  the  occipital  region,  migraines,  and  the 
previous  occurrence  of  neuralgia,  these  being  very  frequent 
symptoms  in  persons  with  athyroidia  or  hypothyroidia.  Most 
characteristic  are  alterations  in  the  mental  condition.  Thus, 
memory  for  recent  events  may  be  gone.  There  may  be  apathy, 
with  hesitation  before  every  movement,  such  persons  disliking 
to  move  about.  They  may  sit  indefinitely  in  the  same  position. 
As  already  mentioned  in  the  chapter  on  the  influences  of  the 
ductless  glands  upon  the  nervous  system  such  people  are  fre- 
quently somnolent.  Therefore  we  must  inquire  about  the  hours 
of  sleep.  Besides  sleeping  long,  such  persons  are  apt  to  awake 
in  the  night  after  dreams  of  a  terrifying  nature.  Our  diagnosis 
of  a  condition  of  athyroidia  or  hypothyroidia  has  often  been 


How  to  Determine  the  Probable  Duration  of  Life.         71 

helped,  by  inquiring  whether  such  persons  have  seen  little  ani- 
mals (rats  or  mice)  creeping  through  the  room  while  sitting 
quiet,  or  before  going  to  sleep.  Such  a  symptom  has  been 
described  by  Murray,3  in  his  book  on  myxcedema,  in  the  early 
stages  of  this  disease;  the  mind  being  then  so  much  altered 
that  even  manias  of  persecution  and  suicide  may  arise. 

Neurasthenia  is  a  disease  which,  as  we  have  tried  to  show, 
is  very  often  based  upon  changes  in  the  ductless  glands,  espe- 
cially the  thyroid,  sexual  glands,  and  pituitary  body.  The  same 
holds  good  for  hysteria.  Therefore  the  presence  of  such  con- 
ditions will  influence  us  in  our  judgment  as  to  the  future  of 
such  persons.  In  cases  of  great  nervousness,  especially  when 
associated  with  mental  depression,  there  is  less  resistance  to 
infection,  for  causes  already  mentioned  (see  Chapters  III  and 
L).  Great  mental  excitability  may  predispose  to  certain  dis- 
eases which  shorten  life,  like  diabetes,  and  in  people  in  whom, 
owing  to  an  unstable  nervous  system,  there  is  a  frequent  increase 
in  the  blood-pressure,  the  possibility  of  apoplexy  is  to  be  feared, 
if  such  persons  are  of  a  plethoric  build.  The  wear  and  tear  of 
life  is  certainly  far  more  felt  by  persons  whose  minds  are  very 
easily  impressed  and  excited  by  events  of  little  importance ;  and, 
considering  the  great  influence  of  mind  upon  body,  persons,  who 
like  a  weak  tree  are  easily  beaten  down  by  the  smallest  storm, 
will  have  less  chance  of  long  life  than  persons  who  have  a 
better  control  over  themselves  and  stronger  will  power  (see 
"Hygienics  of  the  Mind,"  Chapter  L). 

Having  thus  briefly  described  the  principal  functions  gov- 
erned by  the  thyroid  gland :  shown  how,  by  observing  changes  in 
these  functions,  we  can  judge  as  to  the  healthy  condition  of  this 
gland,  let  us  now  see  if  any  means  exists  by  which  we  can  ascer- 
tain the  functionating  condition  of  the  other  ductless  glands. 

After  the  thyroid  the  sexual  glands  claim  our  attention, 
as  these  glands  are  of  the  utmost  importance  on  account  of  their 
enormous  influence  upon  the  processes  of  metabolism  and  the 
3 Murray:     "Disease  of  the  Thyroid  Gland,"  p.  72,  London,  1901. 


72  Old  Age  Deferred. 


maintenance  of  life  (see  Chapter  V).  We  must  first  call  to 
mind  that  their  work  is  essentially  under  the  influence  of  the 
thyroid,  changes  in  which  invariably  produce  changes  in  the 
sexual  glands.  Thus,  in  degenerated  conditions  of  the  thy- 
roid, we  find  impotency  in  men  and  sterility  in  women.  In  such 
conditions  atrophy  of  the  testicles,  or  of  the  ovaries,  can  often 
be  found.  These  clinical  observations  can  be  confirmed  by 
experiments.  Thus  Lanz4  found  sterility  common  in  goats 
whose  thyroids  had  been  extirpated.  In  cretins  an  atrophic 
condition  of  the  testicles,  or  of  the  ovaries,  is  present  as  a  rule, 
and  such  patients  very  frequently  show  lack  of  sexual  desires. 

Direct  examination  of  the  sexual  glands  can  be  more  easily 
carried  out  in  men  than  in  women. 

The  presence  of  varicose  veins  is  of  great  importance,  as 
varicoceles  are  generally  accompanied  by  great  disturbances  of 
the  nervous  system,  sometimes  even  going  as  far  as  insanity. 
Suicide  is  not  unfrequently  committed  in  such  a  condition. 

After  the  testicles  the  prostatic  gland  must  be  examined. 
As  direct  examination  of  this  gland  is  only  possible  by  a  painful 
examination  through  the  rectum,  we  shall  have  to  inquire  into 
the  condition  of  the  functions  of  this  gland.  We  must  find  out 
whether  there  is  a  flow  of  prostatic  liquid  and  semen  (frequency 
of  pollution).  It  must  be  remembered,  however,  that  the  flow 
of  a  little  semen  in  constipation  and  sexual  abstinence  has  no 
importance. 

We  must  specially  inquire  about  previous  attacks  of  gonor- 
rhoea. Examining  the  urine  in  two  fractions,  we  must  ascertain 
whether  the  first  fraction  is  as  clear  as  the  second.  The  pres- 
ence of  a  few  filaments  tells  a  tale  of  previous  gonorrhoea,  but 
is  of  no  consequence  for  the  prognosis.  It  may  be,  however, 
that  they  possibly  indicate  the  presence  of  gonococci  in  the  deeper 
lying  glands  of  the  urethra  which,  after  sexual  excesses,  can 
again  come  to  the  surface  even  after  years. 

Inquiring  for  gonorrhoea  in  the  past,   we  must  find  out 
4  Lanz :     hoc.  cit. 


How  to  Determine  the  Probable  Duration  of  Life.         73 

whether  the  patient  was  treated  by  local  applications  with  instru- 
ments to  the  posterior  part  of  the  urethra,  this  being  the  only 
radical  treatment  of  chronic  gonorrhoea.  As  a  rule,  every 
chronic  gonorrhoea  invades  the  posterior  part  of  the  urethra 
and,  usually,  inflammation  of  the  posterior  part  of  the  urethra 
involves  also  the  prostatic  gland. 

The  presence  of  strictures  and  hypertrophy  of  the  prostate, 
unless  they  occur  in  connection  with  a  gonorrhoea,  are  indicative  of 
a  faulty  activity  of  those  glands  which  influence  the  formation 
of  fatty  or  connective  tissue  in  the  body,  as  will  be  shown.  It 
may  indicate  changes  in  the  thyroid,  after  extirpation  or  degen- 
eration of  which  the  connective  tissue  in  the  body  is  increased,  to 
which  fact  is  also  largely  due  the  occurrence  of  prostatic 
hypertrophy. 

We  must  inquire  as  to  the  passage  of  urine.  An  inter- 
rupted stream  with  pain  on  micturition  may  indicate,  in  elderly 
persons,  a  hypertrophy  of  the  prostate,  especially  if  these  pains 
are  more  frequent  in  cold  weather.  The  bladder  must  be  exam- 
ined for  the  presence  of  stone.  The  presence  of  stone,  as  also 
of  long-standing  gleet  and  strictures  that  are  not  cured,  lessen 
the  chances  of  a  long  life,  the  dangers  of  cystitis,  and  ascend- 
ing pyelonephritis,  and  nephritis,  hanging,  as  the  sword  of 
Damocles,  over  the  heads  of  their  unfortunate  possessors. 

Gonorrhoea,  if  it  occurs  frequently  and  attacks  the  pros- 
tate, is  a  great  danger  both  to  the  mental  stability  and  sexual 
powers.  The  presence  of  great  sexual  desires,  with  more  or  less 
impotence,  must  also  be  taken  into  consideration  when  we  are 
collecting  evidence  to  find  out  the  chances  of  long  life  in  an 
individual. 

Regarding  the  examination  of  the  female  sexual  organs 
and  of  their  functions,  it  cannot  be  the  object  of  these  lines 
to  describe  how  to  conduct  a  thorough  gynecologic  exami- 
nation. We  must  limit  ourselves  to  those  points  by  which 
we  can  ascertain  the  condition  of  those  functions  which  are 
under  the  control  of  the  ovaries,  with  special  reference  to  their 


74  Old  Age  Deferred. 


internal  secretion.  Thus,  we  need  merely  observe  whether  the 
external  sexual  characteristics  {e.g.,  breasts,  hips,  etc.)  are  well 
developed,  since  these  are  under  the  direct  influence  of  the 
internal  secretion  of  the  ovaries. 

A  chlorotic  condition  allows  us  to  draw  the  inference  that 
a  faulty  condition  of  the  ovaries  exists  (ovarian  origin  of  chlo- 
rosis— v.  Noorden),  and  also  of  the  thyroid,  as  this  gland  often 
shows  change  in  chlorosis.  The  extirpation  of  these  glands  is 
followed  by  a  diminution  in  the  number  of  red  blood-corpuscles 
and  in  the  percentage  of  haemoglobin.  Both  of  these  elements  of 
the  blood  can  be  increased  by  the  use  of  thyroid  or  ovarian  ex- 
tracts, as  has  been  noted  by  several  authorities. 

The  condition  of  menstruation  can  give  us  valuable  infor- 
mation. The  late  appearance  of  the  first  menstrual  period, 
irregularities  of  menstruation,  its  appearance  at  irregular  inter- 
vals, and  frequent  disappearance  for  months,  will  give  us  an 
unfavorable  idea  of  the  ovarian  activity,  especially  when  each 
menstrual  period  is  accompanied  by  pain.  So  will  sterility,  as 
this  condition  is  common,  not  only  in  association  with  ovarian 
inactivity  (if  not  due  to  malpositions  of  the  uterus  or  impo- 
tency  of  the  husband),  but  also  with  thyroid  deficiency.  On 
the  other  hand,  too  frequent  pregnancies  or  miscarriages  will 
also  unfavorably  influence  our  judgment,  as  these  agencies  have, 
as  a  rule,  a  deteriorating  effect  upon  these  important  glands, 
causing  their  exhaustion  and,  at  the  same  time,  that  of  the 
thyroid.  In  women  with  thyroid  insufficiency  and  general  loss 
of  muscular  tone,  prolapse  of  the  uterus  may  be  frequent,  and  also 
metrorrhagia.  As  Hertoghe  found,  we  can  stop  uterine  haem- 
orrhages in  women  with  thyroid  insufficiency  by  the  adminis- 
tration of  thyroid  extracts.  The  history  of  previous  gonor- 
rhceal  infection  must  be  specially  investigated,  as  this  disease, 
if  not  treated,  which  is  unhappily  so  often  the  case,  will  always 
involve  the  ovaries,  causing  their  destruction  and  often  their 
obliteration.  Gonorrhoea  in  women  is  far  oftener  overlooked 
than   in   men,   as   it   so   often  passes   for   a   simple   discharge, 


IIoiv  to  Determine  the  Probable  Duration  of  Life.         75 

until  by  microscopical  examination  gonococci  are  found,  and 
the  ovaries  already  injured.  It  is  a  sad  fact  that  a  large  majority 
of  the  cases  of  pelvic  disease  in  married  women  are  due  to  infec- 
tion by  the  husband,  for  an  enormous  number  of  men  enter  upon 
marriage  with  gonorrhoea  that  is  imperfectly  cured,  or  not  cured 
at  all.  Let  us  hope  that  there  will  come  a  time  when  a  law  will 
be  passed  obliging  every  man  to  be  examined  thoroughly  before 
entering  upon  marriage,  especially  for  gonorrhoea  and  syphilis. 
Such  legal  precautions  would  soon  check  the  transmission 
of  these  diseases  to  the  wife  and  of  syphilis  to  the  innocent 
descendants.  It  may  be  that  thus,  to  a  large  extent,  the  propa- 
gation of  some  of  the  greatest  scourges  of  humanity  can  be 
checked,  viz. :  of  tuberculosis,  alcoholism,  and  crime5  which,  as 
shown  previously,  flourish  on  the  soil  prepared  for  them  by 
hereditary  syphilis. 

A  total  lack  of  sexual  desire  in  women  is  not  normal,  and 
may  indicate  changes  in  the  ovaries.  On  the  other  hand,  there 
is  an  increase  of  sexual  desire  at  the  period  of  augmented 
ovarian  activity,  as  in  the  days  preceding  menstruation.  We 
have  had  the  opportunity  of  hearing  praise  of  ovarian  treat- 
ment from  husbands  of  women  with  tendencies  to  sexual  fri- 
gidity. 

Very  valuable  information  about  the  activity  of  the  ovaries 
can  be  gained  from  the  examination  of  the  breasts.  It  must 
be  borne  in  mind  that  the  ovaries  and  the  breasts  stand  in  very 
close  relation.  Changes  in  the  ovaries  are  always  followed  by 
changes  in  the  breasts,  and  it  is  a  very  interesting  fact  that 
cases  of  cancer  of  the  breast  have  been  cured  by  extirpation  of 
the  ovaries. 

Comparing  the  breasts  of  an  innocent  young  girl  between 
sixteen  and  twenty  years  with  those  of  women  of  the  same  age 
leading  an  immoral  life,  or  of  women  after  many  pregnancies 
or  in   advanced   age,    we   notice   at   once   the   great   difference 

5  Arnold   Lorand:     "Pathogeny  of   Crime,"   Address   to  the   Philadelphia 
Med.  Jurisprudence  Society.     Monthly  Cyclopaedia  of  Practical  Medicine,  1907. 


76  Old  Age  Deferred. 


between  the  large  flabby  breasts  and  the  firm  tissue  of  a  young 
girl  leading  a  moral  life.  According  to  our  observations  we 
have  described6  cases  of  fatty  enlargement  of  the  breasts,  fol- 
lowing all  those  agencies  which  are  hurtful  to  the  ovaries,  as 
masturbation,  sexual  excesses,  many  pregnancies,  etc.  On  the 
other  hand,  in  degenerated  conditions  of  the  ovaries  and  thy- 
roid, especially  if  these  conditions  are  congenital,  we  may  find 
the  breasts  quite  undeveloped. 

After  the  thyroid  and  ovaries  we  will  direct  our  attention 
to  the  pituitary  body.  Direct  examination  of  this  ductless 
gland  being  out  of  question,  owing  to  its  position  on  the  base 
of  the  skull,  in  the  sella  turcica,  we  have  to  judge  of  its  vitality 
by  indirect  methods.  We  know  that  by  the  alterations  of 
this  gland  a  condition  is  produced,  called  acromegaly,  charac- 
terized by  enlargement  of  the  toes,  fingers  and  nose,  prominence 
of  the  lower  jaw,  sinking  in  of  the  temple  and  of  the  fossa  canina 
in  the  cheek-bones,  prominence  of  the  occipital  bone,  etc.  As 
with  all  diseases  of  the  ductless  glands,  besides  the  extreme  form 
just  described,  which  constitutes  the  highest  degree  of  such  a 
degeneration,  there  are  also  marked  cases  where  all  of  the  above 
deformities  are  only  slightly  pronounced.  We  must  inquire 
whether  the  features  of  such  persons  have  changed,  or  the  nose, 
hands,  and  feet  become  larger.  This  is  best  determined  by 
comparison  of  old  and  recent  photographs. 

A  history  of  headache,  especially  nocturnal,  of  mental 
change,  e.g.,  great  susceptibility  or  symptoms  of  neurasthenia, 
taken  together  with  the  external  appearances,  may  aid  our  diag- 
nosis. The  simultaneous  discovery  of  an  ocular  lesion  (hemi- 
anopsia) will  confirm  our  suspicions  beyond  doubt. 

The  pancreas,  also,  can  only  be  examined  by  indirect  evi- 
dences of  its  activity.  A  history  of  frequent  or  occasional  epigas- 
tric colic,  of  large  quantities  of  unformed  shapeless  stools  of  a 
yellow  or  yellow-gray  color,  containing  undigested  fat,  together 


6  International    Congress   of   Medicine,   Lisbon,   1906,   reported   in   Presse 
medicale,  1907. 


How  to  Determine  the  Probable  Duration  of  Life.         77 

with  loss  of  weight,  will  make  us  think  of  the  possibility  of  disease 
of  the  pancreas.  The  most  exact  proof  of  such  change  can  only 
be  obtained  by  microscopical  examination  of  the  faeces. 

Examination  of  the  urine  for  sugar  can  also  tell  us  whether 
there  is  disease  of  the  pancreas,  especially  of  those  parts  of  the 
pancreas  which  constitute  a  ductless  gland,  independently  of  the 
rest  of  the  viscus,  namely,  the  islands  of  Langerhans.7 

As  Mering  and  Minkowski8  first  showed,  every  dog  whose 
pancreas  is  extirpated  invariably  becomes  diabetic,  and  this  dia- 
betes is  similar  to  that  of  man.  In  many  cases  of  diabetes 
changes  in  the  pancreas  have  been  found  at  autopsy;  and- 
although  a  good  number  of  cases  without  any  apparent  change 
in  the  pancreas  have  been  recorded,  the  cause  of  these  has  been 
revealed  by  an  American  author,  Dr.  Opie,9  then  of  the  Johns 
Hopkins  University  in  Baltimore.  This  author  has  found  in 
a  few  cases  of  diabetes  alterations  in  the  islands  of  Langerhans 
in  the  pancreas.  This  fact  has  been  confirmed  by  a  good  many 
authors,  of  whom  I  may  mention  Sobolew,10  Weichselbaum11 
and  Stengel,  Sauerbeck,  and  others.  As  is  invariably  the  case, 
the  statements  of  these  authorities  have  been  attacked  by  others, 
as  Hanseman,  who  have  found  no  such  changes  in  the  islets  in 
diabetes.  We  must,  however,  state  here,  that  an  apparently 
perfect  anatomical  condition  of  glandular  structure  after  death 
need  be  no  proof  of  a  perfect  secretory  activity  during  life. 
Every  epithelial  formation,  and  the  islands  of  Langerhans  are  of 
this  nature,  must  furnish  a  secretion,  and  this  flows  in  every 
gland  only  under  a  nervous  stimulation.  As  Pawlow  has  shown, 
the  pancreas  secretes  under  nervous  impulse.  Therefore  the 
findings  of  pathological  anatomy  cannot  show  us  whether  these 
glands  have  been  secreting  properly  during  life  or  not,  especially 
in  a  nervous  disease  such  as  diabetes. 


1  Langerhans :    These,  Berlin,  1869;   G.  Lange. 

8  Mering  und  Minkowski:  Archiv  fur  exper.  Path,  und  Pharm.,  xxvi,  1889. 

9  Opie:     Journal  of  Experiment.  Medicine,  p.   827,   1901. 
io  Virchow's  Archiv,  clxviii,  p.  1. 

11  Wiener  klin.  Wochenschrift,  1901-1902. 


78  Old  Age  Deferred. 


According  to  the  experiments  of  Diamare  and  Kuliabko, 
the  islands  of  Langerhans  furnish  a  secretion  which  aids  in  the 
inversion  of  grape  sugar.  We  have  shown  at  meetings  of  the 
Biological  Department  of  the  Hamburg  Medical  Society  (Ger- 
many), and  of  the  London  Pathological  Society,  specimens  of  the 
pancreas  of  diabetic  persons  where  there  were  changes  only  in 
the  islands  of  Langerhans  and  none  in  other  parts  of  the  pancreas 
while,  in  one  case,  nearly  the  whole  of  the  pancreas  was  des- 
troyed by  cirrhosis,  but  without  any  diabetes,  for  in  this  case  the 
islands  of  Langerhans  were  not  changed  at  all.  It  is  interesting 
•to  note  that  these  changes  in  the  islands  of  Langerhans  were  also 
present  in  mild  cases  of  diabetes. 

Thus,  the  finding  of  sugar  in  the  urine  usually  indicates  the 
probability  of  changes  in  the  pancreas.  Even  small  quantities 
of  sugar,  such  as  appear  only  after  starchy  meals  (alimentary 
glycosuria  ex  amylo)  may  be  brought  into  connection  with 
changes  in  the  pancreas;  for  Wille12  found  in  Hamburg  from  a 
large  series  of  autopsies,  that  in  a  considerable  number  of  cases 
with  alimentary  glycosuria,  there  were  also  changes  in  the  pan- 
creas. 

We  must  not  forget  the  very  important  fact,  that  even  when 
we  find  no  sugar  we  cannot  at  once  exclude  diabetes.  There  are 
many  cases  of  mild  diabetes  which  do  not  show  any  sugar  on  an 
ordinary  diet.  To  recognize  these  cases  we  must  give  them  a 
test  meal  of  either  about  three  ounces  of  grape  sugar  two  hours 
after  a  light  breakfast  of  coffee  and  a  roll,  or,  as  we  have  recom- 
mended in  our  book  on  the  rational  treatment  of  diabetes,13  we 
must  give  a  test  meal  of  much  starchy  food,  such  as  rice  and  cakes, 
and  examine  the  urine  two  hours  later.  If  then  no  sugar  is 
found,  or  not  exceeding  0.2  per  cent.,  diabetes  may  be  excluded. 
Persons  with  O.I  per  cent,  to  0.3  per  cent,  of  sugar  after  such  a 
starchy  test  meal  may  be  considered  as  on  the  border  line  of 
diabetes.     Such  persons  show  a  diminished  tolerance  of  carbo- 

12  Quoted  after  Professor  Oser:     Deutsche  klinik.,  vol.  v,  p.  158. 

13  Second  edition,  Berlin,  1909. 


How  to  Determine  the  Probable  Duration  of  Life.         79 

hydrates,  and  they  have  lost  the  power  to  consume  all  the  sugar 
they  introduce  into  their  body.  Therefore,  especially  if  they 
come  of  diabetic  parents,  they  should  avoid  eating  much  starchy 
food  so  as  not  to  develop  further  this  dangerous  tendency. 

Diabetes,  in  the  majority  of  cases,  considerably  shortens 
the  patient's  life.  Mild  cases  of  diabetes  may  however  live 
for  fifteen  or  twenty  years,  or  often  even  longer.  In  pre- 
dicting the  chances  of  longevity  in  diabetic  subjects  everything 
depends  on  the  question  whether  diacetic  acid  has  been  found  in 
the  urine  or  not.  This  can  be  easily  ascertained  by  putting  a 
few  drops  of  a  solution  of  perchloride  of  iron  into  a  test  tube 
with  the  diabetic  urine.  If  diacetic  acid  is  present,  the  liquid 
will  become  Burgundy  red  in  color,  and  the  deeper  this  red  color, 
the  greater  is  the  percentage  of  diacetic  acid  present.  In  such 
cases  the  chances  are  very  bad,  such  patients  living  on  an  average 
for  only  one  to  two  years.  Exceptions  to  this  rule,  however,  are 
not  infrequent,  and  we  know  of  a  case  of  acromegaly  with 
severe  diabetes,  who  has  passed  large  quantities  of  diacetic  acid 
for  the  last  fourteen  years. 

Cases  of  severe  diabetes,  with  diacetic  acid,  can  often  be 
easily  recognized  by  their  appearance.  They  are  thin,  the  cheeks 
are  often  flushed,  and  they  show  nearly  all  the  signs  of  a  myxce- 
dematous  condition,  as  already  described,  whereas  cases  of  mild 
diabetes  present  often  symptoms  of  hyperactivity  of  the  thyroid 
gland,  as  in  exophthalmic  goiter.  As  we  have  shown,  diabetes 
is  often  due  to  an  overactivity  of  the  thyroid  gland,14  as  well  as 
to  degeneration  of  the  pancreas,  these  glands  being  antagonistic 
to  one  another.  This  is  confirmed  and  amplified  by  Sajous,  who 
ascribes  one  form  of  diabetes  to  overactivity  of  the  adrenal  sys- 
tem, which  includes  the  thyroid  gland.  Overactivity  of  the  latter 
organ  may  also  be  followed  by  its  exhaustion,  with  symptoms  of 
myxoedema,  as  is  the  rule  in  severe  diabetes. 

Patients  with  mild  diabetes  often  have  a  fresh  look  and  a 


14  "Die  Entstehung  der  Zuckerkrankheit,"  Berlin,   1903,  and  its   French 
translation,  Maloine,  Paris,  1904. 


80  Old  Age  Deferred. 


rosy  face,  and  very  frequently  look  much  younger  than  they 
are.  We  believe  that  the  healthy  working  condition  of  their 
thyroids  has  something  to  do  with  this  fact. 

The  pancreas  is  a  very  important  organ  for  the  main- 
tenance of  life  as  it  produces  certain  bodies  (enzymes)  which 
are  of  enormous  importance]  in  the  assimilation  of  food.  One 
of  these  bodies  (they  are  three  in  number),  helps  the  assimila- 
tion of  albuminous  products  and  is  called  trypsin.  It  also  plays 
an  important  role  in  the  treatment  of  cancerous  growths.  Be- 
sides this  the  pancreas  produces  an  enzyme  that  helps  the  assimi- 
lation of  the  carbohydrates  (amylopsin)  and  another  that  is 
indispensable  for  the  perfect  assimilation  of  fat  (steapsin). 

As  we  have  shown  by  experiments  made  in  the  laboratory 
of  Professor  Minkowski  (then  in  Cologne),  the  pancreas  stands 
in  definite  relation  to  the  thyroid.  These  two  glands  seem  to 
be  antagonistic  to  one  another,  for  on  extirpation  of  the  pancreas 
of  three  dogs,  thus  rendering  them  diabetic,  in  every  case 
the  thyroid  showed  a  condition  of  hyperactivity,  whereas  in  one 
case,  after  previous  extirpation  of  the  thyroid,  the  pancreas 
showed  an  enormous  number  of  islands  of  Langerhans — (thirty- 
six  to  forty  in  one  field).15 

It  was  also  of  great  interest,  that  each  diabetic  dog  ceased 
to  eliminate  sugar  two  days  after  extirpation  of  the  thyroid. 

As  with  the  thyroid,  the  pancreas  has  also  very  impor- 
tant relations  with  the  liver.  Dr.  Steinhaus  found,  in  a  research 
conducted  in  the  laboratory  of  Professor  Minkowski,  that  in  a 
large  number  of  cases  of  hepatic  cirrhosis  there  were  also  similar 
changes  in  the  pancreas.  Similar  observations  have  also  been 
made  by  Opie,  Amato,  Kliffel  and  Lefas,16  and  others.  This 
may  be  the  reason  that  in  diseases  of  the  liver  we  have  had 
good  results  from  the  administration  of  pancreatic  extract.  In 
every  case  we  have  found  a  better  assimilation  of  food,  and  espe- 
cially a  better  appetite.     This  stomachic  effect  of  pancreatic  ex- 


15  Comptes-Rendus  de  la  Societe  de  biologie,  Paris,  25  Mars,  1904. 

16  Revue  de  rnedecine,  23,  1903. 


How  to  Determine  the  Probable  Duration  of  Life.         81 

tracts  we  have  found  in  nearly  every  case  and  even  when  the 
patients  were  not  suffering  from  pancreatic  or  hepatic  disease. 
(See  also  Chapter  LIV.) 

Still  more  than  the  pancreas  is  the  liver  indispensable  for 
the  maintenance  of  life.  It  destroys  the  deadly  poisons  which  are 
conveyed  to  it  by  the  portal  vein  for  neutralization.  Besides  this 
it  produces  certain  bodies  which  help  to  destroy  poisons  arising 
from  the  decomposition  of  albuminous  food.  (See  also  Chapter 
XIII.) 

The  liver  also  produces  certain  bodies,  as  urea,  which 
play  a  very  important  part  in  metabolism,  and  it  also  serves  as 
a  large  depot  for  glycogen,  the  stored  sugar  of  the  body.  The 
liver  forms  a  large  amount  of  glycogen,  and  stores  it  up  for  the 
wants  of  the  body.  By  a  ferment,  also  produced  by  the  liver 
cells,  the  glycogen  is  transformed  into  sugar,  and  in  this  form 
is  given  off  to  the  body.  If  the  liver  were  extirpated  the  blood 
would  contain  no  more  sugar,  as  was  found  by  Minkowski 
through  experiments  on  animals. 

Besides  sugar,  the  liver  also  produces,  as  just  mentioned, 
another  very  important  substance,  and  this  is  urea.  This  body  is 
produced  in  the  liver  from  ammonia,  which,  as  the  final  product 
of  decomposition  of  albuminous  substances,  is  brought  to  the 
liver  by  the  blood.  From  carbamic  acid,  also,  the  liver  forms 
urea.  Ammonia  and  carbamic  acid  are  poisonous  products 
which  arise  from  the  decomposition  of  albuminous  material,  and, 
by  transforming  them  into  urea,  the. liver  saves  our  body  from 
continuous  intoxication.  Thus  we  can  see  that  in  diseases  of 
the  liver  the  quantity  of  urea  falls  and  the  elimination  of  am- 
monia increases.  A  normal  man  eliminates  about  thirty  to  forty 
grammes  of  urea  in  a  day.  Much  smaller  quantities  per  diem 
would  thus  indicate  diminished  activity  of  the  liver. 

Besides  glycogen  and  urea,  the  liver  also  produces  another 
substance,  which  is  indispensable  to  the  perfect  process  of  diges- 
tion and  assimilation.  This  is  the  bile.  The  bile  transforms 
fat  in  the  intestine  into  an  emulsion,  and  thus  makes  it  possible 


82  .  Old  Age  Deferred. 


for  the  fat-splitting  ferment  of  the  pancreas  to  act  upon  it,  and 
to  split  it  up  into  glycerin  and  fatty  acids,  and  thus  make  it 
serviceable  for  the  uses  of  the  organism.  The  bile  augments 
the  action  of  the  pancreatic  ferments;  it  stimulates  the  move- 
ments of  the  intestine,  and  is  a  powerful  antiseptic  to  the  con- 
tents of  the  intestine,  as  it  hinders  to  a  certain  extent  their  putre- 
faction. Another  important  action  is  that  it  increases  the  water 
content  of  the  fseces,  and  thus  materially  helps  an  easy  evacua- 
tion of  the  bowels. 

After  having  thus  briefly  passed  in  review  the  important 
functions  of  a  healthy  active  liver,  let  us  now  say  a  few  words 
about  its  examination.  The  liver  is  one  of  the  few  ductless 
glands  which  are  available  for  manual  examination  by  percussion 
and  palpation.  We  must  ascertain  if  it  extends  considerably 
below  the  costal  margin,  and  by  palpation  we  must  ascertain 
whether  the  enlarged  liver  is  soft  or  hard  and  cirrhotic.  In  the 
former  condition  we  can  diagnose  hyperactivity  of  the  liver, 
probably  due  to  its  efforts  to  safeguard  the  body  against  a  long- 
continued  intoxication,  as  may  be  the  case  in  those  who  over- 
eat, and  also  in  long-continued  digestive  troubles,  especially 
with  dilatation  of  the  stomach,  chronic  constipation,  etc.  Fol- 
lowing on  this  hyperactivity,  as  is  the  case  with  all  organs,  there 
may  come  an  exhaustion,  more  especially  after  long-continued 
intoxications.  Thus  in  chronic  alcoholism  a  simple  hypertrophy 
of  the  liver  may  go  on  to  cirrhosis,  and  later  the  hypertrophy 
may  be  followed  by  an  atrophy,  with  all  its  harmful  conse- 
quences, as  ascites,  etc. 

On  examining  the  liver  we  must  not  forget  the  sclerotics, 
and  must  note  whether,  on  looking  upward,  there  is  any  yellow 
discoloration. 

While  palpating  the  liver  we  must  specially  note  whether 
it  is  tender,  •  and  also  if  the  gall-bladder  is  tender.  This  is  a 
typical  symptom  of  chronic  inflammation  of  the  gall-bladder, 
or  cholecystitis,  which  is  so  frequently  associated  with  gall-stones. 
We  find  such  a  tender  gall-bladder  very  frequently  in  elderly 


Hozv  to  Determine  the  Probable  Duration  of  Life. 

women,  in  whom  gall-stones  are  particularly  common.  In 
fact,  they  occur  so  frequently  that  Halck17  in  Copenhagen,  found 
them  in  29  per  cent,  of  4140  autopsies  on  persons  above  50  years 
of  age.  However  the  mere  presence  of  gall-stones  does  not 
constitute  gall-stone  disease,  the  essential  point  being  an  inflam- 
mation of  the  gall-bladder  and  bile-ducts.  Such  an  inflammation 
of  the  gall-bladder  is  revealed  by  tenderness  on  pressure  with  the 
examining  hand.  It  is  a  frequent  symptom  of  all  those  conditions 
(as  we  have  found  and  communicated  to  the  French  Congress  of 
Medicine,  1905)  in  which  the  thyroid  or  sexual  glands  are  dis- 
eased. For  instance,  after  pregnancies,  after  infectious  diseases 
in  old  age,  etc.,  it  is  often  accompanied  and  preceded  by  obesity, 
which  is  also  a  consequence  of  inactivity  of  the  thyroid  and  sexual 
glands.  French,  many  years  ago,  observed  enlargement  of  the 
liver  and  a  tender  gall-bladder  in  women  at  the  climacteric,  and 
many  other  authors  have  made  similar  observations.  Hertoghe 
found  such  conditions  common  in  women  suffering  from  inactivity 
of  the  thyroid  or  hypothyroidia. 

It  has  been  found  by  experiments,  made  by  Blumenthal  and 
Jacobi,  that  extirpation  of  the  thyroid  is  followed  by  a  dilation 
of  the  gall-bladder,  and  many  authors  have  noted  the  presence 
of  biliary  constituents  in  the  urine  of  animals  whose  thyroid  has 
been  extirpated. 

,We  can  readily  understand  why  women  with  changes  in 
the  thyroid  and  sexual  glands  are  so  often  attacked  by  gall- 
stone disease.  In  these  women  there  is,  as  a  rule,  atony  of  the 
intestines,  with  habitual  constipation.  This  intestinal  atony  is 
also  accompanied  by  an  atony  of  the  gall-ducts,  and  so  the  bile 
is  more  or  less  stagnant  in  these  ducts. 

As  shown  by  Morat  and  Doyon,18  the  gall-ducts  contract 
rhythmically  every  ten  to  twenty  seconds,  and  the  bile  is  thus 
expressed.  The  periodical  compression  of  the  liver  by  the 
diaphragm  at  each  inspiration  also  helps  this  expression  of  the 


17  Quoted  from  Hoppe-Seyler  in  Nothnagel's  "Practice,"  p.  548,  1904. 

18  Traits  de  Physiologie. 


84  Old  Age  Deferred. 


bile.  Thus  it  flows  under  a  certain  pressure  through  the  chole- 
dochus,  and  it  is  easy  to  understand  that  the  billions  of  microbes 
which  infest  the  intestines,  will  have  great  difficulty  in  passing 
the  narrow  and  tortuous  passages  of  the  bile-ducts  through 
which  bile  is  circulating  at  great  pressure.  And  this  is  of  the 
utmost  importance,  for  if  microbes  are  able  to  pass  the  common 
duct  and  thus  enter  the  bile-ducts,  they  will  set  up  inflammation, 
as  was  shown  by  several  French  authors :  Gombault,  Charcot,  Gil- 
bert, etc. 

Inflammation  of  the  bile-ducts  plays  a  most  important  part 
in  the  origin  of  gall-stone  disease,  for,  as  Naunyn  and  his  pupils 
have  shown,  inflammation  of  the  bile-ducts  leads  to  a  precipita- 
tion of  cholesterin,  and  so  to  the  formation  of  gall-stones. 

In  women  gall-stone  disease  is  more  frequent  than  in  men. 
This  depends  upon  the  greater  frequency  of  diseases  of  the  thy- 
roid and  sexual  glands  in  women.  Changes  in  the  sexual  organs 
produce  an  irritation  of  the  splanchnic  with  checking  of  the  peri- 
staltic movements  of  the  intestine  and,  at  the  same  time,  relaxa- 
tion of  the  muscular  coat  of  the  bile-ducts.  Thus  there  arises 
a  deficient  expression  of  bile,  and  stagnation  follows,  with  invari- 
able immigration  of  bacilli  producing  inflammation  and  precipi- 
tation of  cholesterin  and  gall-stones.  For  the  above-mentioned 
reasons  constipation  is  far  more  frequent  in  the  female,  and 
constipation,  being  always  accompanied  by  atony  of  the  bile-ducts 
with  stagnation  of  the  bile,  directly  exposes  to  the  risk  of  gall- 
stone disease. 

In  men  gall-stone  disease  may  often  be  considered  a  mani- 
festation of  old  age.  It  appears,  as  a  rule,  after  the  fortieth 
year,  and  is  often  brought  about  by  previous  infectious  diseases. 
In  such  cases  obesity  often  develops  first,  and  later  gall-stone 
disease.  For  those  who  are  interested  in  this  subject  we  would 
refer  to  our  communication19  on  the  origin  of  gall-stone  disease 
following   changes    in    certain    ductless    glands.      Considerable, 


19  Archives  generates  de  medecine,  Octobre,  1905,  and  Monthly  Cyclopaedia 
of  Practical  Medicine,  1906. 


How  to  Determine  the  Probable  Duration  of  Life.         85 

sometimes  enormous,  loss  of  weight  is  a  very  frequent  symp- 
tom of  gall-stone  disease,  and  is  probably  due  to  pancreatic 
alterations. 

Gall-stone  disease  may  be  regarded  as  of  great  importance 
in  estimating  an  individual's  prospects  of  longevity,  and  at  the 
same  time  as  a  pathological  manifestation  of  an  inactive  thyroid, 
or  deficient  sexual  glands  in  women.  This  applies  equally  well  to 
the  cause  of  renal  colic,  gravel,  which  was  found  by  Professor 
Sajous  to  be  prevented  by  thyroid  preparations  and  a  suitable  diet. 

Constipation,  an  important  predisposing  cause,  has  been 
shown  to  be  an  expression  of  such  conditions.  The  truth  of 
these  assertions  is  proved  by  experimental  evidence. 

Extirpation  of  the  thyroid  provokes  important  changes  in 
the  liver.  In  myxcedema  there  is  a  condition  of  hepatic  cirrhosis, 
as  shown  by  Prun-Hudden,  Vermehren,20  and  others.  Two 
years  after  we  had  shown  that  the  thyroid  and  liver  stand  in 
close  relation  to  one  another,  Professor  Neusser,  of  Vienna, 
brought  forward  the  same  conclusion  at  the  German  Congress 
of  Internal  Medicine  in  1906. 

Another  important  gland  that  has  a  very  close  connection 
with  the  thyroid  is  the  kidney.  A  direct  examination  of  this 
organ  is  not  possible,  but  we  have  means  of  readily  judging  of 
its  efficiency  by  observing  how  it  performs  its  function.  This  is  to 
eliminate  waste  and  poisonous  products  from  the  body  by  means 
of  its  secretion — the  urine.  Thus  from  the  examination  of  the 
urine  we  may  gather  all  the  information  necessary  about  the 
activity  of  the  kidneys. 

In  examining  the  urine  we  must  first  pay  attention  to  its 
appearance,  the  daily  amount,  and  its  specific  gravity.  Less 
than  about  two  pints  a  day  of  a  light  colored  urine,  with  a  specific 
gravity  below  1020,  indicates  a  faulty  action  of  the  kidneys, 
and  the  possibility  of  a  large  amount  of  toxic  products  being 
retained,  instead  of  being  eliminated.  Such  a  urine  can  often 
be  seen  in  cases  of  thyroid  insufficiency,  as  this  condition  of  the 
20  Over  Myxcedemet,  Kjobenhavn,  1895. 


86  Old  Age  Deferred. 


thyroid  causes  a  diminution  in  the  activity  of  the  kidneys.  As 
we  have  shown  in  a  communication  to  the  Paris  Biological 
Society,203,  the  thyroid  and  the  kidneys  are  very  closely  related, 
changes  in  the  thyroid  always  being  followed  by  changes  in  the 
kidneys.  Thus  it  was  found  by  Albertoni  and  Tizzoni,  by  Blum 
and  others,  that  extirpation  of  the  thyroid  is  followed  by  fibrosis 
of  the  kidneys.  Interstitial  nephritis  is  the  rule  in  myxcedema, 
and  is  very  frequent  in  all  conditions  with  insufficiency  of  the 
thyroid.  In  such  patients  the  quantity  af  urine  is  dimin- 
ished, and  also  its  specific  gravity,  as  well  as  the  quantity  of 
urea  and  uric  acid,  which  in  consequence  are  retained  in  the  body. 

The  quantity  of  the  eliminated  uric  acid  being  diminished,  its 
retention  in  the  body  explains  why  gout  is  so  frequent  in  people 
with  thyroid  insufficiency,  and  why  these  persons  so  often  com- 
plain of  rheumatic  pains.  As  we  have  shown  in  our  above- 
mentioned  communication,  gout  is  due  to  a  degenerative  change 
in  the  thyroid  and  kidneys,  with  retention  of  uric  acid  as  a  sequel. 

The  presence  of  albumin  in  quantities  greater  than  0.5 
gramme  to  the  liter  is  of  grave  import,  and  denotes  important 
change  in  the  kidneys.  Smaller  quantities,  or  just  a  trace,  may 
not  be  of  great  importance.  Traces  of  albumin  occur  from  a 
great  number  of  causes,  and  are  often  due  to  the  passage  of 
toxic  products  through  the  kidney  which  this  organ  eliminates, 
as  one  of  its  main  functions  is  to  eliminate  toxic  products  from 
the  body. 

More  serious  than  small  quantities  of  albumin  is  the  appear- 
ance of  casts  and  renal  epithelium.  These,  if  present,  indicate 
a  destructive  process  in  the  kidneys.  Even  the  occasional  occur- 
rence of  hyalin  casts  is  not  without  danger,  for,  according  to 
Professor  Senator,21  of  Berlin,  hyalin  casts  are  formed  by  degen- 
eration of  the  epithelium  of  the  convoluted  tubules,  which  play 
an  important  role  in  the  separation  of  solid  products  from  the 
blood  into  the  urine.     The  loss  of  these  structures  means  a  ham- 


20»  hoc.  cit. 

21  Die  Erkrankungen  der  Nieren,  second  edition,  Berlin,  1906. 


How  to  Determine  the  Probable  Duration  of  Life.         87 

pering  of  the  most  important  function  of  the  kidneys.  Even 
when  we  find  only  one  such  cast  in  one  or  two  specimens,  we 
must  not  forget  that  a  pint  of  the  urine  may  contain  a  very 
large  number,  and  thus  every  day  large  quantities  of  valuable 
kidney  elements  are  wasted  and  one  of  the  most  important 
functions  in  our  body  is  hindered.  Therefore  we  must  not  pass  by 
such  a  condition  of  things  without  serious  thought  for  the  future 
of  such  persons.  The  length  of  their  lives  will  largely  depend 
upon  their  diet,  just  as  in  cirrhosis  of  the  liver.  If  these  persons 
are  addicted  to  an  abundant  meat  diet,  their  chances  of  longevity 
will  certainly  be  smaller  than  with  milk  and  vegetable  food.  As 
we  have  seen,  the  liver  is  constantly  dealing  with  poisons  arising 
from  the  decomposition  of  albuminous  food,  especially  meats. 
The  kidneys  are  destined  to  eliminate  such  products  from  the 
blood  and  pass  them  out  with  the  urine.  We  will  treat  of  this 
subject  later  in  a  separate  chapter. 

In  patients  with  diseases  of  the  kidneys,  the  condition  of 
the  skin  is  of  the  utmost  importance,  as  the  skin  is  our  second 
kidney.  Therefore  patients  with  thyroid  insufficiency  have 
less  chance  of  a  long  life  if  their  kidneys  are  in  any  way  inca- 
pacitated. 

Besides  the  above-named  vital  organs,  there  are  certain 
portions  of  our  anatomy  which  are  also  of  importance  in  the 
determination  of  our  chances  of  life.  Take,  for  example,  the 
nose.  In  the  children  of  parents  with  degenerated  thyroids  there 
is  a  great  tendency  to  adenoid  vegetations.  These  are,  strictly 
speaking,  not  a  disease  of  childhood  alone,  for  often  they  may 
be  met  with  in  adults,  even  in  middle  age.  If  large  they  necessi- 
tate breathing  through  the  mouth  instead  of  through  the  nose, 
especially  at  night.  Such  children  are  liable  to  frequent  catarrhs, 
and  what  is  more  serious,  to  pulmonary  troubles.  They  are  also 
liable  to  suppurative  otitis  media  and  frequent  attacks  of  ton- 
sillitis. These  frequent  attacks  of  tonsillitis  may  constitute  a 
serious  danger,  as  they  may  induce  an  inflammation  of  the  kid- 
neys.   As  a  rule,  in  such  cases  the  nephritis  passes  off  in  a  few 


88  Old  Age  Deferred. 


days,  often  without  being  recognized,  the  symptoms  being 
ascribed  only  to  the  tonsillitis.  Although  the  acute  symptoms 
may  have  disappeared  and  nothing  remain  but  a  few  red  blood- 
corpuscles  in  the  urine  and  occasionally  a  few  casts  and  epithe- 
lial cells,  yet  under  the  ashes  the  fire  may  still  creep  on  and 
chronic  nephritis  develop.  In  fact,  a  good  number  of  cases  of 
chronic  nephritis  whose  origin  is  wrapped  in  mystery  are  due 
to  such  a  tonsillitis. 

The  condition  of  the  teeth  must  also  be  inspected,  for  people 
without  sufficient  teeth  cannot  chew  their  food  properly,  and 
thus  gastric  and  intestinal  catarrhs  may  arise. 

Just  as  important,  if  not  more  so,  than  the  condition  of  the 
above-mentioned  vital  organs,  is  the  mental  state.  Thousands 
of  years  ago  it  was  a  manifest  truth  that  the  mind  governs  the 
body.  In  judging  an  individual's  chances  of  long  life,  we  cannot 
omit  the  importance  of  his  mental  character.  As  a  rule  a  man 
with  a  well-balanced  mind,  who  is  not  disturbed  by  the  smaller 
worries  of  life,  has  more  chances  of  a  green  old  age  than  a 
man  whose  easily  impressionable  mind  exposes  him  to  continual 
agitation  and  anxiety,  and  who  is  overwhelmed  by  the  slightest 
untoward  event.  A  man  who  is  a  born  optimist  and  who  views 
everything  in  a  rosy  light,  has  got  far  more  chance  than  a  pes- 
simist who  sees  everything  in  a  cloud.  A  man  who  is  ambitious 
and  never  satisfied  is  more  liable  to  mental  and  physical  change 
than  one  who  asks  for  little  and  easily  gets  it.  Being  disap- 
pointed in  his  ambition,  as  so  often  happens,  he  becomes  despond- 
ent, especially  if  he  is  lacking  in  will  power,  which  depends  on 
the  activity  of  the  thyroid  as  previously  mentioned.  In  this  con- 
dition he  may  not  only  lose  his  appetite  and  become  ill-nourished, 
but  he  is  also  more  liable  to  succumb  to  the  incessant  attacks  of 
microbes,  among  which  he  lives,  and  which  gain  easy  access  to 
the  body  in  melancholic  conditions.  Sorrow  may  act  in  the  same 
harmful  manner. 

The  chances  of  a  bachelor  or  spinster  for  a  long  life  are 
always  less  than  those  of  a  married  person.     Single  people  are 


How  to  Determine  the  Probable  Duration  of  Life.        89 

more  subject  to  nervous  change  and  digestive  troubles,  and  have 
a  greater  tendency  to  become  despondent  and  melancholic.  In 
bachelors,  also,  the  acquisition  of  contagious  diseases  is  a  con- 
tinual danger,  and  when  they  get  older  after  their  former  merry 
lives,  if  merry  it  was,  gloom  invariably  follows.  Married  life 
is  the  best  guarantee  for  a  long  life  and  happy  old  age  (see 
Chapter  XLVIII). 

Before  closing  this  chapter  we  would  state  that  it  was  not 
our  intention  to  give  a  description  of  the  physical  examination 
of  a  patient  from  the  point  of  view  of  life  insurance,  but  to  indi- 
cate certain  points  which  must  guide  us  in  forming  an  opinion 
on  a  person's  chance  of  longevity.  All  vital  phenomena  are 
under  the  influence  of  the  internal  secretions  of  the  ductless 
glands,  which  govern  every  organ  of  our  bodies.  Therefore 
everything  depends  upon  finding  out  the  condition  of  these 
glands.  Any  well  instructed  physician  can  make  a  thorough 
examination  of  the  different  organs  of  the  body  for  the  pttr- 
poses  of  life  insurance;  therefore  we  did  not  think  it  necessary 
to  describe  here  the  examination  of  the  heart  or  lungs,  etc. 

By  such  examination  of  the  ductless  glands  we  are  not  only 
able  to  forecast  the  approximate  length  of  life,  but  we  are  able 
to  judge  a  patient's  power  to  withstand  disease  when  we  are 
called  to  his  bedside.  If  we  find  the  ductless  glands  of  such  a 
patient  (especially  the  thyroid  and  adrenals,  kidneys  and  liver) 
in  good  working  order,  we  can  predict  a  successful  and  rapid 
termination  to  the  malady.  It  is  easy  to  understand  that  any 
one  with  a  healthy  skin,  normally  acting  bowels,  and  plentiful 
urine,  will  more  readily  eliminate  poisonous  products  than  a 
person  with  a  dry  skin,  constipation,  and  scanty  urine.  Also 
his  tissues  will  be  in  better  condition,  and  in  the  case  of  wounds 
granulations  will  more  quickly  form  and  fractures  heal  readily 
with  firm  callus. 

Such  an  examination  as  the  above  can,  however,  also  help  us, 
as  we  readily  shall  understand,  to  foretell  the  chances  of  a  person 
as  to  the  prolongation  of  youth  and  the  retardation  of  old  age. 


CHAPTER  VIII. 
On  the  Causation  of  Old  Age. 

We  have  seen  in  the  first  chapter  of  this  book  that  the 
symptoms  of  old  age  may  appear  in  quite  young  persons  after 
changes  in  the  ductless  glands,  especially  the  thyroid,  ovaries, 
testicles,  etc.  We  have  also  shown  how  these  glands  influence 
the  condition  of  the  tissues,  and  our  external  appearance, .  our 
immunity  from  infections  and  intoxications,  and  the  condition 
of  our  nervous  system  and  mind.  We  have  also  seen  how  these 
wonderful  glands  influence  the  length  of  our  life  and  our  pros- 
pects of  a  green  old  age,  and  thus  it  is  evident  that  these  glands 
are  in  close  relation  with  the  origin  of  old  age.  It  is  justi- 
fiable, therefore,  to  enter  fully  into  a  discussion  as  to  whether 
old  age  is  really  due  to  degeneration  of  the  ductless  glands, 
which  supposition  must  have  occurred  to  anyone  who  has  read 
the  previous  chapters  of  this  book. 

Sir  Victor  Horsley,  of  University  College  Hospital,  Lon- 
don, was  the  first  to'  bring  old  age  into  causal  relation  with 
degeneration  of  the  thyroid,  and  after  him  Vermehren  and 
Ewald  of  Berlin. 

In  a  communication  we  made  to  the  Biological  Society  at 
Paris,  December  4,  1907,  we  showed  that  old  age  is  not  alone 
due  to  degeneration  of  the  thyroid,  but  to  changes  in  several 
ductless  glands,  of  which  the  chief  are  the  thyroid,  ovaries,  testi- 
cles, adrenals,  and  pancreas.  In  a  communication  to  the  Inter- 
national Medical  Congress  in  Lisbon,  in  1902,  we  added  to  these 
glands  the  liver  and  kidneys,  which  also  possess  an  internal 
secretion. 

Let  us  now  see  if  there  is  any  evidence  in  support  of  such 
a  statement. 
(90) 


The  Causation  of  Old  Age.  01 

As  we  shall  show,  such  proofs  do  exist  and  they  are  of  a 
pathological,  anatomical,  experimental,  and  clinical  nature.  To 
begin  with,  it  is  a  well-established  fact  that  at  a  certain  age  the 
different  ductless  glands  show  important  changes,  notably  an 
increase  of  connective  tissue,  with  subsequent  degeneration  of 
the  secreting  tissue. 

Sir  Victor  Horsley1  found  that  the  thyroid  gland,  after  a 
certain  age,  shows  an  increase  of  connective  tissue,  with  fatty 
degeneration  of  the  epithelium  and  shrinking  (concentration) 
of  the  contents  of  the  follicles.  Hale  White2  also,  examining 
at  autopsy  seventy  thyroid  glands,  found  an  atrophic  condition 
in  old  subjects,  an  atrophy  which  is  more  marked  the  older  the 
subject,  and  that  these  changes  are  already  present  in  the  thyroids 
of  persons  fifty  years  old. 

The  thyroid,  together  with  the  parathyroids,  have  been 
found  degenerated  in  old  age  by  Erdheim.3  Bauman  found 
only  very  little  iodine  in  the  thyroid  of  aged  persons. 

Let  us  add  that,  luckily,  not  every  thyroid  shows  important 
changes  after  the  age  of  forty  or  fifty,  although  there  is  usually 
a  slight  increase  of  connective  tissue  at  that  age.  On  the  other 
hand  there  are  thyroids  in  subjects  of  advanced  age  which  show 
no  important  degenerative  change.  This,  however,  is,  accord- 
ing to  our  experience  at  autopsies,  a  very  rare  occurrence.  The 
point  of  main  importance  is  the  amount  of  colloid  substance 
present.  A  thyroid  with  much  colloid,  if  it  is  of  normal  quality 
(which  can  be  recognized  by  the  way  it  stains  with  eosin),  is 
a  thyroid  of  good  activity.  As  we  know,  the  thyroid  contains 
more  iodine  than  any  other  part  of  the  body.  The  main  bulk 
of  the  iodine  in  our  body  comes  from  the  thyroid.  It  fellows 
from  the  investigations  of  Docent  Oswald,4  in  Zurich,  that  the 


1  "On  the  Thyroid  and  Pituitary  Bodies,"  British  Medical  Journal,  1890, 
and  Proceedings  of  the  Royal  Society^  1886. 

2 Hale  White:    Med.-Chirurg.  Transactions,  vol.  Ixxi,  182. 

3  Beitrage  zur  path.  Anatomie,  xxxiii,  p.  158,  1903. 

4  Oswald:       Zeitschrift  fur  physiolog.  Chemie,  1899,  and  Virchow's  Archiv, 
169,  p.  444,  1902. 


92  Old  Age  Deferred. 


quantity  of  iodine  in  the  thyroid  depends  upon  the  amount  of 
colloid  substance.  Hence  a  thyroid  with  much  colloid  substance 
contains  much  iodine,  and  a  large  goiter  composed  of  connec- 
tive tissue  alone  and  containing  no  colloid,  cannot  contain  any 
iodine. 

Differing  with  a  famous  French  physician  who  said  that 
the  age  of  a  man  depended  upon  his  arteries,  we  would  state 
that  it  depends  upon  the  quality  of  his  thyroid.  For  the  condi- 
tion of  the  arteries,  as  we  have  shown  in  different  parts  of  this 
book  (Chapters  II  and  VI),  depends  very  much  upon  the  con- 
dition of  the  thyroid  gland,  which  governs  the  whole  circulatory 
system. 

The  parathyroid  glands,  which  are  in  relation  with  the  thy- 
roid, and  changes  in  which  may  produce  cramps,  as  shown  by 
Jeandelize,5  Pineles,6  etc.,  also  present  an  increase  of  connective 
tissue,  with  fatty  degeneration  of  the  epithelium,  in  old  age,  as 
was  shown  by  Erdheim,7  of  the  Vienna  Pathological  Institute. 

As  is  well  known,  the  ovaries  also,  between  the  ages  of 
forty-six  and  fifty,  undergo  important  changes  and  involution, 
with  consequent  cessation  of  the  menses.  There  is  an  increase 
of  connective  tissue  with  degeneration  of  the  epithelial  struc- 
ture. There  is  also  a  retrograde  metamorphosis  of  the  Graafian 
follicles  into  fibrous  tissue.  The  testicles  have  been  found  atro- 
phied in  old  age  by  Professor  Langhans,8  but  there  are  many 
exceptions,  as  shown  by  S.  Spangaro.9 

As  Sajous10  and  we11  also  have  shown  in  our  already  cited 
researches,  that  the  various  ductless  glands  are  closely  related,  and 
thus  changes  in  the  thyroid  are  always  accompanied  by  changes 
in  the  other  ductless  glands.     This  rule  applies  to  the  present 

5  L'insuffisance  thyroidienne  et  parathyroidienne,  Paris,  1904. 

6  Grenzgebiete  f.  Med.  Chirurg.,  1905. 

7  Erdheim :      hoc.  cit. 

8  Langhans:       "Hoden    Atropine,"    Handbuch    der    Deutschen    Chirurgie, 
Stuttgart,  1887. 

9  Spangaro :     Anatomische  Hefte,  lx,  1902. 

10  Sajous :     hoc.  cit. 

11  hoc.  cit. 


The  Causation  of  Old  Age.  93 


case  and  after  senile  changes  in  the  thyroid,  with  increase  of 
connective  tissue,  the  other  ductless  glands  also  show  similar 
changes.  These  are  found  in  the  pituitary  body,  the  adrenals, 
the  liver,  and  kidneys.  We  have  several  times  insisted  upon  this 
fact  in  various  chapters  of  this  book. 

The  adrenals  of  old  people  have  been  examined  by  Miner- 
vini,12  and  he  found  a  true  cirrhosis  of  these  glands  which  had 
included  nearly  the  whole  gland.  He  also  found  drops  of  fat 
in  the  cells  of  the  medulla.  Dellamarel:i  found  a  hypertrophic 
condition  of  this  gland  in  old  age. 

In  nature  every  cause  has  a  sequel.  Therefore,  when  we 
see  such  important  changes  in  glands  with  internal  secretions, 
there  logically  must  be  sequels  to  the  alterations  in  these  impor- 
tant organs.  And  these  exist.  When  the  thyroid  is  degener- 
ated, to  a  greater  or  less  extent  all  those  symptoms  appear 
which  are  characteristic  of  changes  in  the  functions  governed 
by  the  thyroid,  and  of  which  we  have  spoken  in  previous  chapters. 

Therefore,  when  the  thyroid  is  degenerated,  symptoms  ap- 
pear which  are  characteristic  of  myxcedema.  And,  indeed,  Sir 
Victor  Horsley  was  the  first  to  draw  attention  to  the  fact  that 
in  old  age  we  find  all  the  symptoms  of  myxcedema;  and  after 
him,  Vermehren14  and  Ewald.15  They  have  compared  the 
symptoms  of  myxcedema  with  those  of  old  age,  and  found  the 
two  conditions  very  similar.  According  to  our  own  observations 
the  most  prominent  of  these  corresponding  symptoms  are : — 

The  wrinkles  on  the  face  and  the  drooping  of  the  lower  eye- 
lids, in  extreme  cases  amounting  to  ectropion.  Then  the  great 
number  of  wrinkles  on  the  hands  of  myxedematous  people,  even 
at  an  early  age,  and  the  feeling  of  cold  in  the  hands  and  feet  and 
their  bluish  color. 

With  advancing  age,   obesity  is  often  the  first   symptom, 

i2Minervini:     Journal  d'anat.  et  de  physiol.,  p.  449  and  p.  639,  1904. 
iSDellamare:     Soc.  de  biologie,  17  Oetobre,  1903. 

14  Studier  over  Myxoedemet,  Kjobenhavn,   1895. 

15  Ewald:     "Die  Erkrankungen  der  Schilddriise,"  Nothnagel's  Handbuch, 
Vienna,  1896. 


94  Old  Age  Deferred. 


just  as  in  myxoedema,  and,  as  we  have  said  above,  obesity  can 
be  caused  by  degeneration  of  the  thyroid  and  sexual  glands. 

The  hair  in  both  conditions  is  very  often  gray,  and  there 
is  atrophy  of  the  papillae  of  the  hair  and  of  the  sebaceous  and 
sudorific  glands,  with  dryness  and  falling  out  of  the  hair. 

Constipation  or  irregularity  of  the  bowels  is  also  common. 
There  is  often  great  fatigue,  slow  speech,  and  an  apathetic  con- 
dition in  both  these  states.  The  memory  shows  the  same  typical 
deficiency,  events  of  long  ago  being  more  easily  remembered 
than  those  of  quite  recent  date.  The  character  of  the  patient 
becomes  egotistical  and  avaricious.  There  is  great  sensibility 
to  cold  and  difficulty  in  keeping  warm.  The  urine  is  generally 
below  the  normal  quantity ;  often  it  is  scanty  and  of  low  specific 
gravity,  with  retention  of  solid  constituents.  The  processes  of 
oxidation  are  diminished  both  in  typical  myxoedema  and  in 
advanced  old  age.  There  is  a  diminution  of  the  blood-corpuscles 
and  of  haemoglobin  in  both  conditions. 

After  the  initial  obesity  in  early  myxoedema  and  old  age, 
there  comes  as  a  second  stage  a  loss  of  fat,  characteristic  of  the 
advanced  stage  of  myxoedema  (the  cachectic  stage)  and  advanced 
old  age. 

There  is  an  increase  of  fatty  tissue  after  extirpation  of 
the  thyroid  gland,  and  later  of  connective  tissue,  just  as  in 
myxoedema  and  old  age.  This  increase  of  connective  tissue  is 
typical  of  old  age.  It  first  appears  in  the  arteries,  leading  to 
atheroma,  and  the  typical  symptoms  of  arteriosclerosis.  In 
myxcedematous  persons,  although  they  may  still  be  young,  we 
find  atheromatous  arteries  and  arteriosclerosis.  Impotence  is 
common  in  myxoedema,  especially  in  advanced  cases,  and  is  also 
found  in  senility,  being  more  marked  the  greater  the  patient's  age. 

There  is  no  denying  the  fact  that  in  old  age  we  find,  besides 
degeneration  of  the  thyroid,  symptoms  of  degeneration  in  vari- 
ous other  tissues  and  functions,  and  the  question  now  arises, 
whether  these  changes  in  the  tissues  are  really  the  sequel  of 
previous  degeneration  of  the  ductless  glands,  or  whether  both 


The  Causation  of  Old  Age.  95 

are  only  accidental  and  in  no  causal  relation  We  have  already- 
answered  this  question  four  years  ago  in  our  communication 
to  the  Paris  Biological  Society,  showing  that  old  age  is  due  to 
degeneration  of  the  ductless  glands,  and  stating  that  these  glands 
govern  the  tissues  and  not  vice  versa.  Still,  we  shall  enter  here 
more  fully  upon  this  question,  showing  by  experimental  and 
clinical  evidence  that  the  changes  in  the  ductless  glands  are 
primary,  and  followed  by  a  degeneration  of  the  tissues  as  a  con- 
sequence. 

We  can  produce  experimentally  typical  symptoms  of  old 
age  in  young  animals  by  extirpation  of  the  ductless  glands,  more 
especially  the  thyroid,  ovaries,  and  testicles. 

When  we  extirpate  the  thyroid  gland  of  an  animal  we  get 
an  increase  of  fat  in  the  subcutaneous  tissue,  or  an  increase  of 
connective  tissue.  We  know  of  the  case  of  a  young  bull  which, 
two  months  after  extirpation  of  the  thyroid,  gained  about  thirty 
kilos  in  weight,  due  to  an  increase  in  fat.  The  same  thing 
occurred  in  a  colt.  We  are  indebted  for  our  knowledge  of 
both  these  cases  to  Dr.  Hertoghe,  of  Antwerp,  the  well-known 
authority  on  the  thyroid  gland. 

After  extirpation  of  the  thyroid  gland  prominent  writers 
have  found  a  diminution  in  the  processes  of  oxidation;  and  by 
thyroid  gland  feeding  we  can  augment  these  processes,  as  was 
shown  by  Vermehren,  Magnus-Levy,  Thiele,  Nehring,  and 
many  others.  This  property  of  the  thyroid  gland  is  made  use 
of  in  the  medicinal  treatment  of  obesity.  Since  writing  these 
lines  we  have  observed  a  loss  of  forty  pounds  in  a  man,  a  patient 
of  Professor  Launois,  of  Paris,  who,  after  this  loss,  felt  better. 
We  treated  him  in  Carlsbad  for  six  weeks  with  thyroid  extracts, 
and  the  average  loss  was  about  a  pound  a  day.  True,  this  patient 
was  also  taking  Carlsbad  water,  but  we  have  never  seen  so  con- 
siderable a  loss  due  to  this  water  alone.  The  diet  of  this  patient 
had  not  been  strict.  This  loss  of  weight,  then,  is  mainly  to  be 
ascribed  to  the  thyroid  treatment.  This  treatment  is  dangerous, 
however,  unless  carefully  regulated  by  a  physician. 


96  Old  Age  Deferred. 


Thus  extirpation  of  the  thyroid  is  undoubtedly  in  causal 
relationship  to  obesity,  which,  as  already  mentioned,  is  often 
the  first  symptom  of  old  age.  But  it  also  can  produce  another 
sign  of  old  age,  and  this  is  the  increase  of  connective  tissue  in 
the  various  organs  and  tissues.  That  connective  tissue  forma- 
tion is  an  attribute  of  old  age  has  been  clearly  shown  by 
Demange  and  Oettinger,  who  found  at  every  autopsy  on  old 
persons  an  increase  of  connective  tissue  in  the  walls  of  the 
capillaries.  Ord  and  Mahomet  found  exactly  the  same  thing 
in  the  capillaries  of  persons  suffering  from  myxcedema.  This 
has  been  proved  experimentally  by  Professor  Eiselsberg,16  of 
Vienna,  who  found  atheromatosis  of  the  aorta  and  other  blood- 
vessels in  dogs  whose  thyroids  he  had  removed. 

This  increase  in  connective  tissue  has  been  found  in  various 
viscera  after  removal  of  the  thyroid;  thus  it  was  found  by 
Kishi17  in  the  liver  of  one  hundred  and  fifty  dogs  and  monkeys. 
Rosenblatt  and  Jeandelize18  also  described  an  interstitial  hepa- 
titis in  similar  cases. 

The  same  change  has  also  been  noted  in  the  kidneys  after 
extirpation  of  the  thyroid  {e.g.,  Blum19  found  an  interstitial 
nephritis),  and  in  the  brain  an  increase  of  neuroglia  occurs,  as 
observed  by  Blum,  Walter  Edmunds,  and  others. 

Increase  of  connective  tissue  in  the  skin  is  a  common  occur- 
rence after  thyroid  extirpation,  and  the  name  "myxcedema"  is 
probably  derived  from  the  fact  that  in  some  cases,  as  the  dis- 
ease advances,  the  connective  tissue  is  transformed  into  a  muci- 
noid  substance.  The  name  "cachexie  pachydermatique,"  as  sug- 
gested by  Charcot,  seems  to  be  far  more  adequate. 

Formation  of  fat  and  of  connective  tissue  is  not  only  seen 
after  removal  of  the  thyroid,  but  can  also  be  observed  after 
extirpation  of  the  sexual  glands,  the  ovaries  and  testicles. 


16  "Die  Krankheiten  der  Schilddriise,"  Stuttgart,  1901. 

17  Virchow's  Archiv,  p.  260,  1904. 

18  hoc.  cit. 

19  Blum :  hoc.  cit. 


The  Causation  of  Old  Age.  97 

As  mentioned  in  Chapter  II,  Loewy  and  Richter,20  of  Berlin, 
observed  that  removal  of  the  sexual  glands  always  produced 
a  diminution  of  the  oxidation  processes. 

The  experiments  of  Prof.  Loewy  and  Prof.  P.  F.  Richter 
are  not  invalidated,  in  our  opinion,  by  the  experiments  of  Luthje, 
who  did  not  find  an  increase  in  metabolism  after  ovarian  feeding. 
The  reason  for  this  may  be  that  he  was  not  in  possession  of  active 
extracts.  Anyone  who  works  with  animal  extracts  knows  what 
a  great  difference  there  is  between  various  organo-therapeutical 
preparations,  some  being  more  efficacious  than  others. 

As  a  rule  castrated  animals  take  on  fat,  and  this  fact  has  for- 
mally years  been  made  use  of  by  farmers.  At  the  same  time 
the  flesh  of  such  animals  acquires  a  better  flavor,  the  pronounced 
flavor  of  the  meat  of  non-castrated  animals  being  objectionable 
to  some  consumers.  This  demonstrates  the  very  instructive  fact 
that  the  internal  secretion  of  the  testicles  has  its  effect  on  all 
parts  of  the  body. 

Castration  in  man  is  very  frequently  followed  by  obesity 
and  symptoms  of  old  age.  Thus  the  eunuchs  of  eastern  coun- 
tries are  very  often  fat  and,  at  the  same  time,  look  much  older. 

The  influence  of  the  ovaries  upon  fat  formation  can  also 
be  shown  by  their  therapeutical  action  in  obesity.  Although 
not  so  active  as  thyroid  extracts,  we  have  found  that  by  the 
combined  use  of  thyroid  and  ovarian  extracts,  we  could  produce 
a  considerable  loss  in  weight,  when,  by  thyroid  treatment  alone, 
we  could  not  obtain  it.  This,  however,  is  only  in  the  case  of 
women.  We  will  treat  of  this  subject  more  fully  in  the  chapter 
on  ovarian  treatment. 

Besides  the  above-mentioned  experimental  facts,  which 
show  that  these  attributes  of  old  age — obesity  and  increase  of 
connective  tissue — can  be  produced  by  removal  of  the  thyroid 
or  sexual  glands,  we  also  have  to  deal  with  facts  gained  by  clin- 
ical observation,  which  show  that  any  cause  inimical  to  the  duct- 

20Archiv   fiir  Anat.  u.   Physiol.,   Supplement,   1899;    and  Ergebnisse  der 
Physiologie,  ii,  1902. 

7 


98  Old  Age  Deferred. 


less  glands,  especially  the  thyroid  and  ovaries,  may  bring  about 
old  age.  Take,  for  example,  infectious  diseases.  They  have  a 
very  damaging  effect  on  the  various  ductless  glands,  especially 
so  if  they  are  of  long  duration.  Their  influence  upon  the  thy- 
roid has  been  clearly  shown  by  various  observers.  (Roger  and 
Gamier,  Crispino,  Torri,  Bayon,  de  Quervain,  and  others.  See 
Chapter  III.) 

Not  only  the  thyroid  gland,  but  other  ductless  glands,  are 
affected  by  infectious  diseases,  and  in  the  third  chapter  of  this 
book  we  have  shown  that  the  adrenal  glands  show  alterations 
indicating  hyperactivity  in  infectious  diseases. 

The  pituitary  gland  is  also  altered  in  infections,  as  shown 
in  the  same  chapter. 

Changes  in  the  pituitary  body  may  also  be  a  factor  in  pro- 
ducing premature  old  age.  It  is  a  fact  that  all  people  suffering 
from  acromegaly  appear  much  older  than  their  age.  In  fact,  one 
of  the  first  symptoms  that  arouses  the  anxiety  of  the  relatives 
of  such  a  patient  is  that  he  looks  so  much  older,  and  it  is  only  later 
that  they  notice  the  overgrowth  of  the  nose,  the  hands,  and 
feet.  Since,  in  many  people  who  are  getting  older,  the  head  and 
nose  may  increase  in  size,  we  may  suppose  that  this  is  the  clinical 
expression  of  senile  changes  in  the  pituitary  body.  There  is  a 
condition  known  as  "acromegalic  fruste,"  in  which  the  symptoms 
are  only  slightly  pronounced  and  which  is  often  unrecognized. 
As  we  have  already  said,  all  diseases  of  the  ductless  glands  may 
be  only  partially  developed.  This  is  due  to  the  fact  that  only 
a  proportion  of  the  thousands  of  follicles,  of  which  such  a  gland 
is  composed,  need  be  affected. 

The  ovaries  and  testicles  also  show  changes  as  an  evidence 
of  their  fight  against  infections,  and  we  have  mentioned  the  find- 
ings of  Professor  Metschnikoff  with  regard  to  these  glands. 

In  every  severe  infectious  disease  the  liver  shows  great 
change  in  its  parenchymatous  tissue,  with  a  subsequent  increase 
of  connective  tissue. 

The  increase  of  connective  tissue  in  various  organs,   and 


The  Causation  of  Old  Age.  99 

especially  in  the  blood-vessels,  after  infectious  diseases,  can  be 
regarded  as  an  illustration  of  our  remarks  on  these  same  changes 
following  degenerations  of  the  thyroid.  It  is  a  well  recognized 
fact  that  atheroma  can  be  caused  by  various  infectious  diseases, 
and  can  also  be  artificially  produced  by  several  infectious  agents. 

The  kidneys,  through  their  role  as  eliminative  organs,  usually 
suffer,  even  more  than  the  other  glands,  in  the  course  of  infec- 
tious diseases.  Even  a  slight  angina  may  produce  an  acute 
parenchymatous  nephritis,  and  the  more  virulent  the  infection, 
the  more  will  the  kidneys  suffer. 

Not  infrequently,  unknown  to  us,  important  parts  of  the 
renal  tissue  are  lost  after  such  infections,  and  a  chronic  nephritis 
may  creep  on  insidiously.  After  such  loss  there  may  be  pro- 
liferation of  connective  tissue,  and  the  kidneys  thus  become  unable 
to  fulfill  the  most  important  eliminative  functions  in  the  body. 
Owing  to  this  incomplete  elimination,  toxic  substances  may  be 
retained  in  the  body. 

From  the  above  considerations  we  can  see  how  important 
it  is  to  guard  against  the  risk  of  infection.  This  is  often  impos- 
sible, considering  the  billions  of  microbes  by  which  we  are  sur- 
rounded day  and  night.  The  best  precaution  is  to  keep  those 
organs  in  good  working  order  which  safeguard  us  against 
infections — i.e.,  the  ductless  glands. 

Even  more  potent  than  infectious  diseases  in  producing  old 
age  are  the  results  of  degenerative  changes  in  the  ovaries. 
The  effects  of  castration  have  already  been  mentioned.  Much 
in  the  same  way  do  those  causes  act  which  exhaust  the  internal 
secretion  of  the  ovaries,  e.g.,  many  pregnancies,  or  sexual  ex- 
cesses. We  must  take  into  consideration  the  fact  that,  as  shown 
by  many  authors,  the  different  ductless  glands  are  altered  during 
pregnancy  (Launois,21  Guieysse,  etc.).  Many  mothers  of  large 
families  look  old  before  their  time,  as  do  also  many  of  those 
who  lead  a  professedly  immoral  life.     Even  in  young  girls  we 

21  Launois  etMulon:     "Hypophyse  et  femme  enceinte,"  Societe  de  biologie, 
p.  448,  21  mars,  1903;  and  These  a  la  Faculte  des  Sciences,  30  juin,  1904. 


100  Old  Age  Deferred. 


can  see  the  consequences  of  such  deteriorating  agencies  in  hyper- 
trophy of  the  mammae,  developing  in  very  short  time,  and  also 
a  tendency  to  deposition  of  fat  on  the  abdomen,  which  becomes 
pendulous  in  women  who  have  had  many  children.  The  features 
of  women  who  indulge  in  sexual  excesses  undergo  a  striking 
change  even  in  early  life.  They  become  coarse,  bloated,  less 
sharply  defined,  and  the  cheeks  and  chin  become  fat  and  flabby. 
Indeed  we  have  often  been  struck  by  the  great  resemblance  of 
such  a  face  to  that  of  an  early  stage  of  myxcedema,  a  condition  due 
to  deficiency  of  thyroid  secretion,  which  in  turn,  as  shown  by 
Sajous,  influences  other  ductless  glands.  The  effects  of  numer- 
ous pregnancies  are  far  more  marked  if  lactation  is  prolonged. 

Not  all  women  after  many  pregnancies,  or  after  unduly 
frequent  sexual  intercourse,  will  show  symptoms  of  premature 
senility,  as  much  depends  on  heredity  and  also  on  the  surround- 
ings in  which  they  live.  Certainly  if  they  live  in  precarious  cir- 
cumstances, as  do  the  poorer  women  of  the  working  classes  in 
many  European  countries,  especially  Germany  and  Austria, 
where  these  women  perform  hard  bodily  work  and  are  badly 
fed,  and  have  much  sorrow  and  care,  they  will  soon  appear  old ; 
and  women  looking  like  matrons  at  thirty  are  of  common  occur- 
ence in  the  lower  classes  of  these  countries.  But  this  is  seen 
also  in  the  women  of  southern  Europe,  although  they  do  not 
work  so  hard.  This  is  due  to  the  fact  that  in  southern  countries 
girls  reach  puberty  early  and  are  married  very  young,  in  the  East 
often  at  the  age  of  twelve.  Thus,  sexual  activity  begins  earlier 
and  ends  much  sooner.  Its  end,  of  course,  means  the  beginning 
of  old  age.  As  soon  as  retrograde  changes  commence  in  the 
ovaries,  the  summer  of  a  woman's  life  is  over;  and,  just  as 
summer  is  sometimes  prolonged  into  autumn,  so  at  this  period 
of  her  life  may  she  still  retain  strong  sexual  desire.  Happy  the 
woman  whose  heart,  as  well  as  her  ovaries,  undergoes  a  senile  in- 
volution, for  there  is  nothing  more  terrible  for  a  formerly  beauti- 
ful woman  than  to  see  her  charms  wane  while  her  heart  remains 
young. 


The  Causation  of  Old  Age.  101 

Yvette  Guilbert,  in  her  novel  the  "Demi-vieilles,"--  de- 
scribes in  a  picturesque  manner  the  pangs  of  a  woman  at  the 
climacteric  age.  Let  us  quote  a  few  lines:  "They  try  to  remain 
young,  hide  the  gradual  onset  of  their  ugliness,  and  look  for  a 
chance  to  taste  of  love  again.  They  cry  out  for  the  past,  for 
even  while  they  fight  against  time  they  cannot  detain  it  in  its 
course."  This  description,  however,  does  not  apply  only  to  the 
majority  of  middle-aged  women,  but  more  especially  to  profes- 
sional beauties. 

It  can  be  seen  from  these  considerations  how  necessary  it 
is  for  a  woman  who  has  frequent  pregnancies  to  observe  the 
rules  of  hygiene.  That  these  produce  excellent  results  we 
have  proved.  We  know  of  a  score  of  ladies  of  the  aristocratic 
and  wealthy  classes  who,  though  having  six  or  even  seven  chil- 
dren, look  none  the  worse.  A  certain  Austrian  archduchess 
still  remains  a  beautiful  woman,  in  spite  of  her  eight  children  and 
the  fact  that  she  is  a  grandmother.  Such  examples  may  be  fre- 
quent in  old  families  with  this  hereditary  tendency.  Though  the 
bearing  of  many  children  can  hasten  old  age,  yet,  on  the  other 
hand  some  women,  after  the  birth  of  their  first  child,  become 
better  and  fresher  looking.  We  can  see  this  especially  in  girls 
of  twenty  or  more  who,  having  appeared  somewhat  withered 
before  marriage,  begin  to  bloom  afresh  after  the  birth  of  the 
first  child.  Increased  activity  of  the  ovaries  and  thyroid  is  the 
explanation  of  this  phenomenon.  As  already  mentioned,  the 
thyroid  takes  an  active  part  in  ovarian  changes.  In  a  young 
girl  of  fourteen,  just  previous  to  menstruation  and  puberty,  we 
may  find  a  swelling  of  the  thyroid  gland.  During  menstruation 
we  can  often  see  a  distinct  enlargement  of  the  thyroid,  and  at 
the  same  time  certain  nervous  symptoms  such  as  are  usually 
connected  with  thyroid  change. 

Increased  activity  of  the  thyroid  during  pregnancy  is  shown 
by  a  swelling  of  the  gland,  often  causing  a  regular  goiter,  and,  at 
the  same  time,  not  infrequently  by  the  typical  symptoms  of  exoph- 
22  Quoted  after  Professor  Kisch. 


102  Old  Age  Deferred. 


thalmic  goiter.  Lactation  is  also  dependent  upon  thyroid  activity. 
After  prolonged  lactation  there  is  an  exhaustion  of  thyroid 
activity;  and,  on  the  other  hand,  by  giving  thyroid  extract  we 
can  increase  the  flow  of  milk. 

The  swelling  of  the  thyroid  in  the  above  conditions  can  be 
explained  by  the  greater  demand  for  thyroid  secretion,  and  that 
this  hyperactivity  occurs  is  also  shown  by  the  observations  of  the 
early  writers  on  myxoedema.  Morvan,  Ord,  and  Combe  found 
that  myxcedema  was  frequently  caused  by  numerous  pregnancies, 
especially  if  associated  with  prolonged  lactation. 

This  also*  explains  why  women  become  prematurely  old  so 
much  more  frequently  than  men,  for  their  ovaries  are  much 
sooner  exhausted,  in  consequence  of  their  activity  being  much 
greater  than  that  of  the  male  sexual  glands.  There  is  a  much 
greater  demand  not  only  on  the  female  sexual  glands,  but  also  on 
the  female  thyroid,  which  enlarges  every  month  in  many  women, 
and  is  greatly  exhausted  by  each  pregnancy.  As  Hertoghe23 
says,  with  reference  to  this  exhaustion  of  the  thyroid  by  preg- 
nancies, "each  child  demands  one  tooth." 

According  to  Hertoghe,  pregnancies  are  especially  apt  to 
produce  degenerated  conditions  of  the  thyroid  gland. 

Sexual  excesses,  on  account  of  the  concomitant  nervous 
excitement,  are  also  very  prejudicial  to  the  adrenals,  for  just  as 
frequent  nervous  excitement  in  general,  they  produce  alterations 
in  the  blood-pressure  and  favor  the  development  of  arterioscle- 
rosis. 

Sexual  excesses  are  also  very  harmful  to  men,  although 
their  action  on  the  thyroid,  in  men,  has  not  yet  been  ascertained. 
It  is  a  fact,  however,  that  they  diminish  the  resistance  to  infec- 
tions, and  favor  the  onset  of  neurasthenia  and  arteriosclerosis. 

Changes  in  the  thyroid  also  become  manifest  during  the 
climacteric,  and  the  troublesome  nervous  manifestations  at  this 
period  are  largely  due  to  this  fact.     Later,  on  account  of  the 


22 Hertoghe:      "Die  Erkrankungen  der  Schilddriise  und  der  chronische 
gutartige  Hypothyreoidismu,"  Miinchen,  Lehmann,  1900. 


The  Causation  uf  Old  Age.  103 

degeneration  of  the  thyroid  and  ovaries  in  many  of  these  women, 
there  is  an  accumulation  of  fat,  of  a  bacon-like  character,  in  the 
same  situations  as  was  described  above  in  women  after  many 
pregnancies  and  sexual  excesses — viz.,  the  breasts,  the  hips,  and 
the  abdomen.  The  facial  appearance  of  these  women  who  be- 
come obese  after  the  climacteric  resembles  that  of  a  typical  case  of 
early  myxcedema.  In  the  later  stages,  as  old  age  advances,  just 
as  in  myxcedema,  the  fat  may  disappear  and  be  replaced  by 
great  thinness  and  emaciation — the  cachectic  stage  of  myxcedema. 
This  is  less  frequently  seen  now-a-days,  on  account  of  the  im- 
provement and  checking  of  the  disease  by  thyroid  treatment. 

It  js  a  very  strange  fact  that  although  sexual  abuses  soon 
bring  about  symptoms  of  old  age,  as  do  also  many  pregnancies, 
clinical  observations  show  that  total  suppression  of  sexual  activity 
is  also,  if  not  still  more,  a  powerful  factor  in  the  production  of 
premature  senility.  There  is  no  denying  the  fact  that  spinsters, 
after  the  age  of  thirty  or  forty,  often  look  older  than  married 
women  with  small  families.  See  also  our  chapter  on  the 
"Hygiene  of  the  Sexual  Glands"  on  this  subject,  in  which  wTe 
show  by  experimental  evidence  the  dangers  of  the  total  suppres- 
sion of  sexual  activity. 

Evidently  nature  will  not  be  trifled  with,  and  the  ovaries 
and  testicles  are  made  by  the  Almighty  to  serve  a  certain  pur- 
pose, just  as  any  other  organ.  Their  remaining  in  total  idle- 
ness is  no  less  harmful  than  in  the  case  of  any  other  organ.  We 
fail  to  see  for  what  reason  this  organ  alone  should  be  made  an 
exception,  and  to  deny  this  fact  would  be  hypocrisy. 

Persons  who  live  in  total  sexual  abstinence  are  very  often 
of  a  nervous,  neurasthenic,  or  even  melancholic  disposition.  If 
we  consider  how  intimate  are  the  relations  of  the  sexual  organs 
with  the  thyroid,  we  cannot  exclude  the  possibility  of  changes 
in  this  important  gland  under  such  conditions. 

The  relationship  between  the  sexual  glands  and  the  thy- 
roid is  also  demonstrated  by  experimental  evidence.  Thus  Cecca 
found,  after  extirpation  of  the  ovaries  or  testicles,  that  the  thy- 


104  Old  Age  Deferred. 


roid  shows  an  accumulation  of  colloid  substance ;  again,  Jayle  saw 
the  appearance  of  exophthalmic  goiter  in  a  case  after  castration; 
and,  on  the  other  hand,  Prof.  Hoffmeister,  of  Strassburg,  found 
a  premature  ripening  of  the  follicles  in  the  ovaries  after 
thyroidectomy. 

Freund  constantly  found  goiter  in  cases  of  fibromyoma  of 
the  uterus,  and  in  two  cases  the  goiter  has  disappeared  after 
operation  on  the  uterine  tumor. 

It  is  a  well-known  fact  that  exophthalmic  goiter  can  be 
improved  by  ovarian  extracts,  as  Latzko,  of  Vienna,  and  others, 
have  shown. 

Changes  in  the  thyroid,  as  a  rule,  produce  certain  changes 
in  the  sexual  glands.  Thus,  in  exophthalmic  goiter  menstrua- 
tion is  usually  irregular  and  often  disappears.  In  myxcedema 
there  is  atrophy  of  the  ovaries  and  sterility.  The  above  con- 
ditions in  man  often  produce  sterility. 

In  partial  cases  of  myxcedema  metrorrhagia  is  frequent. 
By  giving  thyroid  extracts  these  uterine  haemorrhages  may  be 
stopped. 

After  having  shown  that  old  age  can  be  caused  with  more 
or  less  certainty  by  degenerative  changes  in  the  sexual  organs, 
we  will  now  try  to  show  that  it  can  also  be  caused  by  various 
kinds  of  intoxication.  Especially  is  this  true  of  large  quantities 
of  alcohol  continued  for  many  years. 

Alcohol  specially  influences  the  ductless  glands.  Small 
quantities  may  at  first  stimulate  their  action,  but  large  quantities, 
if  taken  for  a  very  long  time,  will  cause  degeneration. 

In  the  third  chapter  of  this  book  we  have  already  briefly 
mentioned  the  bad  effects  of  alcohol  upon  the  ductless  glands. 
We  have  seen  that,  as  de  Quervain,  Hertoghe,  etc.,  have  shown, 
alcohol  produces  very  marked  degeneration  of  the  thyroid 
gland.  This  has  been  proved  by  autopsies  on  chronic  drunkards. 
As  well  as  on  the  thyroid,  alcohol  also  acts  upon  the  other  duct- 
less glands.  It  acts,  for  instance,  upon  the  adrenals.  Its  action 
in  small  doses  is  similar  to  that  of  adrenalin.    Alcohol  in  small 


The  Causation  of  Old  Age.  105 

tonic  doses  excites  the  activity  of  the  splanchnic  nerves,  and  so 
may  produce  an  increased  flow  of  adrenalin  and  a  higher  blood- 
pressure  (see  Chapter  XV). 

Alcohol  in  large  doses  may  also  have  a  degenerating  effect 
on  the  sexual  glands.  Small  doses  can  stimulate,  but  large 
doses  are  decidedly  harmful.  Temporary  impotence  may  result 
in  such  cases,  and  chronic  impotence  in  inveterate  drinkers. 

Though  alcohol  in  large  doses  is  harmful,  and  if  taken  in 
very  large  quantities  for  many  years  can  hasten  old  age,  there 
is  absolutely  no  reason  to  suppose  that  in  small  doses  it  has  any 
etiological  relation  to  senility.  In  fact,  there  are  many  cases 
on  record  of  persons  who  have  taken  alcohol,  especially  wine  in 
limited  quantity,  every  day,  and  have  lived  to  enjoy  a  healthy 
old  age. 

One  of  our  confreres,  a  surgeon  of  Lotharingia  named 
Politiman,  lived  to  be  140.  As  Professor  Pel,  whom  we  quote, 
says,  the  historian  explains  that  this  old  age  was  due  to  the 
medicine  this  worthy  doctor  took  every  day  after  doing  his  work. 
He  had  drunk  his  fill  every  night  since  the  age  of  twenty-five 
years.     Another  surgeon,  Espagno,  lived  to  be  112  with  no  less 

moderate  habits !     Countess  K ,  who  died  in  Nicolajew  in 

Russia,  a  few  years  ago,  at  the  age  of  111  years,  took  daily  a 
cordial  in  the  form  of  a  good  drink  of  cognac ;  and  about  one  and 
a  half  years  ago  the  Daily  Mail  of  London  brought  to  public 
notice  the  case  of  a  Mrs.  Anderson  living  in  Springfield,  near 
Glasgow,  who,  in  spite  of  her  103  years,  was  taking  daily  a  table- 
spoonful  of  whiskey. 

A  strong  point  against  the  anti-alcohol  faddists  is  the  case 
of  Brown,24  an  Irish  peasant,  who,  after  many  years  of  heavy 
beer-drinking,  attained  the  age  of  120.  His  tombstone  exhibits 
the  following  epitaph  : — 

"Here  lies  Brown,  who  became  120  only  through  the  strong 
beer  he  was  drinking.  He  was  constantly  drunk,  and  in  this 
condition  so  terrible,  that  even  death  was  afraid  of  him.  When, 
24  Quoted  after  Professor  Pfliiger. 


106  Old  Age  Deferred. 


however,  one  day  contrary  to  his  habits  he  was  sober  and  in  a 
quiet  mood,  death  got  courage,  seized  him,  and  thus  at  last  was 
triumphant  over  this  incorrigible  drunkard."  (See,  further, 
Chapter  XLI.) 

All  these  examples  merely  show  what  we  have  so  often 
insisted  upon,  that  everything  depends  upon  heredity.  There  are 
many  causes  that  produce  premature  senility.  It  seems,  also,  that 
when  only  a  few  of  these  causes,  or  only  one,  is  acting,  there  is 
a  possibility  of  a  successful  fight  against  it.  It  is  a  different 
matter  when  all,  or  several,  of  the  causes  of  old  age  are  present. 
As  the  German  proverb  says:  "Viele  Hunde  sind  des  Hasen 
Tod"  ("many  dogs  mean  death  for  the  hare"). 

It  is  a  very  interesting  fact  that  seldom  are  all  the  various 
kinds  of  immoderation  united  in  the  same  person.  Thus,  some 
persons  may  drink  and  smoke  heartily  and,  perhaps  as  a  result 
of  the  action  of  these  poisons  upon  the  sexual  glands,  may  be 
better  able  to  combat  their  sexual  instincts.  This  will  also  explain 
the  drinking  habits  of  some  old  spinsters  or  widows.  They 
"drive  out  the  Devil  with  Beelzebub,"  as  the  German  proverb 
says.  On  the  other  hand,  many  total  abstainers  from  alcohol 
and  tobacco  are  far  less  successful  in  combating  their  sexual 
instincts,  and  for  such  persons  marriage  is  a  necessity. 

As  a  rule,  celibatarians  show  symptoms  of  old  age  much 
sooner  than  married  persons. 

If  among  those  addicted  to  drink  there  are  many  instances 
of  long  life,  among  smokers  such  instances  are  much  fewer. 

As  Professor  Pel  says,  there  was  only  one  man  among 
many,  of  those  over  ioo,  who  was  a  smoker  (see  Chapter  XLII). 

It  is  also  of  interest  that  among  very  old  people  we  find 
many  with  very  decided  sexual  tendencies.  Evidently  such  per- 
sons must  be  in  possession  of  very  active  sexual  glands,  which 
indicates  also  a  healthy  thyroid  (see  Chapter  V). 

We  may  class  alcohol  with  tea  and  similar  beverages.  A 
small  amount  every  day  may  be  a  good  thing,  but  in  large  quan- 
tities they  may  all  become  injurious  and  tend  to  shorten  life, 


The  Causation  of  Old  Age.  107 

Tobacco,  according  to  clinical  observations  (Huchard),  is 
apt  to  cause  arteriosclerosis,  just  as  alcohol  in  large  doses;  and 
this  is  also  proved  by  experiments — e.g.,  those  of  Isaac  Adler  and 
Hensel — which  show  that  atheroma  of  blood-vessels  can  be  pro- 
duced in  animals,  experimentally,  by  nicotine. 

Everything  points  to  the  fact  that  tobacco  is  especially 
injurious  to  the  adrenals.  We  will  treat  of  this  subject  more 
fully  later  on  when  discussing  the  hygienic  treatment  of  old  age. 

Many  conditions  of  chronic  intoxication,  and  hence  prema- 
ture senility,  may  be  caused  by  faulty  food,  especially  if  taken  in 
large  quantity,  for  a  long  time.  Even  fresh  albuminous  food 
of  animal  origin,  if  taken  in  large  quantity  every  day,  may  prove 
harmful.  We  have  seen  previously,  in  Chapters  III  and  IV, 
that  meat  produces  by  its  decomposition  certain  poisonous  sub- 
stances which  should  be  destroyed  by  the  ductless  glands. 

Premature  old  age  frequently  occurs  in  people  who  live  a 
sedentary  life,  and  at  the  same  time  consume  much  rich  food  and 
alcohol.  This  causes  obesity,  and  the  muscles  and  nerves  which 
are  little  used,  are  prone  to  show  degenerative  changes  after  a 
certain  time.  At  any  rate  the  processes  of  metabolism  are  dimin- 
ished in  these  structures,  since  their  supply  of  fresh  arterial  blood 
is  always  reduced  if  no  work  or  exercise  be  performed. 

It  is  a  well-known  physiological  fact,  that  nerves  which  are 
inactive  lose  their  excitability  and  degenerate.  This  holds  good 
for  motor  nerves,  and  we  can  also  note  degeneration  of  muscles 
and  organs  which  are  not  used.  Thus,  the  nerves  of  an  extrem- 
ity, after  amputation,  undergo  a  process  of  degeneration.  The 
lower  limbs  of  people  affected  with  infantile  paralysis,  or  of  per- 
sons obliged  to  remain  in  bed  for  a  long  time,  show  atrophic 
changes.  Hence  we  can  easily  see  the  necessity  for  exercise, 
which  increases  the  blood-supply  to  the  muscles  and  nerves.  Work 
of  any  kind,  even  mental  work  alone,  is  a  means  of  preventing 
precocious  senility ;  if  manual  exercise  is  combined  with  it,  it  is 
still  more  efficacious. 

Plutarch,  in  his  "De  educatione  puerorum,"  mentions  that 


108  Old  Age  Deferred. 


a  certain  amount  of  work  improves  the  mind,  but  excess  of  work 
is  prejudicial. 

We  see  the  best  illustration  of  this  fact  m  American  busi- 
ness men.  There  are  no  men  in  any  country  who  do  such  an 
amount  of  work,  and  at  the  same  time  take  so  little  recreation 
or  exercise.  They  sit  in  their  offices  till  dusk,  with  a  few  minutes' 
interval  for  a  hasty  meal,  consisting  mainly  of  meat  that  has 
often  been  kept  in  cold  storage  for  a  long  time,  after  which  busi- 
ness goes  on  again,  at  high  pressure,  until  the  evening.  Then, 
instead  of  walking  home  and  taking  exercise,  they  take  a  car 
or  carriage  to  their  house  or  club,  and  pass  the  evening  in  smok- 
ing and  drinking,  sometimes  to  excess.  Day  after  day  the  same 
killing  of  body  and  nerves  goes  on  till  these  people  look  old  long 
before  fifty,  if,  indeed,  they  reach  that  age.  Arteriosclerosis,, 
diabetes,  gout,  and  obesity  find  many  victims  among  such  men. 
It  is  sad  to  think  how  many  thousands  of  these  splendid  people, 
full  of  genius  and  talent,  could  be  saved  for  their  native  country 
if  only  they  had  been  taught  in  their  youth  the  most  elementary 
rules  of  hygienics.     What  joy  does  money  afford  without  health  ? 

Some  of  the  most  powerful  agencies  in  producing  old  age 
are  frequent  mental  emotions,  especially  sorrow  and  grief. 

It  is  a  common  fact  that  after  such  emotions  people  soon 
look  older.  To  mention  an  example,  there  is  positive  evidence 
that  young  persons,  after  a  mental  shock,  have  become  gray  in 
a  single  night,  thus  developing  abruptly  one  of  the  most  typical 
symptoms  of  old  age. 

That  mental  emotions,  especially  anger,  grief,  sorrow,  fright, 
anxiety,  etc.,  are  very  harmful  to  glands  with  an  internal  secre- 
tion, is  shown  by  a  series  of  clinical  observations.  Sajous  has 
in  fact  termed  sensorium  commune,  i.e.,  the  center  which  receives 
all  shocks,  the  governing  center  of  the  ductless  glands,  located  in 
the  pituitary  body. 

With  mental  emotion  there  is  often  disturbance  of  a  func- 
tion, interference  with  which  is  very  liable  to  hasten  the  onset 
of  old  age,  and  this  is  sleep. 


The  Causation  of  Old  Age.  109 

We  frequently  notice  that  persons  who  have  not  slept  well 
for  several  nights,  especially  if  passed  on  a  railway  journey, 
look  worn  out  and  older.  After  a  good  night's  rest  these  effects 
disappear  and  they  look  fresh  and  younger  again. 

There  are  other  functional  disturbances  which  are  espe- 
cially harmful  as  they  interfere  with  the  elimination  of  harmful 
products  either  introduced  with  the  food  or  found  in  the  body 
{e.g.,  uric  acid).  This  applies  also  to  the  bowels,  perspiration, 
and  diuresis.  When  these  important  functions  are  checked,  there 
is  retention  of  poisonous  products  and  a  condition  of  auto-intoxi- 
cation. These  functions  are  governed  by  the  ductless  glands, 
especially  the  thyroid,  as  we  have  seen  in  Chapter  VI.  It  is  easy 
to  understand  that  by  their  interruption  the  onset  of  old  age  is 
hastened,  as  these  toxins  will  cause  deterioration  and  destruction 
of  epithelium  and  the  formation  of  connective  tissue  in  its  place. 
Retained  poisonous  products  play  a  very  great  etiological  role 
in  the  production  of  arteriosclerosis,  which  is  found  as  a  typical 
symptom  of  old  age  in  the  large  majority  of  aged  persons. 

We  thus  see  that  all  those  agencies  which  by  common  consent 
are  usually  considered  the  most  frequent  causes  of  old  age,  are 
also  very  detrimental,  to  the  ductless  glands,  especially  the  thy- 
roid. They  produce  hyperactivity,  with  subsequent  exhaustion, 
in  these  important  glands.  The  pathological  and  anatomical  changes 
indicating  hyperactivity  give  place  to  those  of  atrophy.  We  have 
given  an  example  of  this  in  discussing  the  changes  in  the  thy- 
roid in  infectious  diseases.  The  formation  of  connective  tissue 
is  the  final  result.  Thus  a  condition  of  the  thyroid  arises  similar 
to  that  in  myxcedema,  which,  as  we  have  stated,  can  be  pro- 
duced by  causes  similar  to  those  which  produce  old  age — i.e., 
infectious  diseases,  exhaustion  of  the  ovaries  after  pregnancies 
or  sexual  excesses,  mental  emotions,  etc. 

The  pathological  and  anatomical  changes  in  the  thyroid,  con- 
sisting of  an  increase  in  the  connective  tissue,  as  in  myxcedema, 
will  logically  produce  clinical  symptoms,  and  these  symptoms  are 
the  same  as  those  of  myxcedema. 


110  Old  Age  Deferred. 


Therefore  we  are  justified  in  assuming  that  old  age  will 
show  the  same  clinical  symptoms  as  myxcedema. 

We  have  shown  that,  given  changes  in  the  thyroid  gland, 
the  other  ductless  glands  will  be  altered  too;  for  instance,  the 
liver  and  kidneys.  These  glands  have  an  important  function  in 
freeing  the  organism  of  poisonous  substances.  As  in  old  age 
their  secreting  elements  are  more  or  less  atrophied,  they  are 
unable  to  execute  their  task  properly,  and  these  harmful  products 
will  accumulate.  Now,  there  are  important  organs  which  can  act 
as  corollaries  to  these  glands.  These  are  the  intestines  and  the 
skin.  They  also  are  under  the  influence  of  the  thyroid.  In  dis- 
eased conditions  of  the  thyroid  they  are  unable  to  perform  their 
functions  regularly.  The  poisons  will  not  be  eliminated,  and 
thus  a  condition  of  auto-intoxication  must  arise. 

Just  as  after  extirpation  of  the  thyroid  there  is  an  increase 
of  connective  tissue  or  fat  in  various  organs  and  tissues  (as 
Demange  found),  so  in  old  age  there  arises  a  condition  of  sclero- 
sis in  the  tissues  and  organs. 

On  this  account,  strictures  of  the  urethra  are  readily  pro- 
duced in  old  men  who  have  had  gonorrhoea  scores  of  years  ago. 
The  prostate  gland,  owing  to  the  abundant  formation  of  connec- 
tive tissue,  will  also  enlarge,  although  usually  sclerosis  of  an 
organ  is  accompanied  by  diminution  in  size.  In  the  central  nerv- 
ous system,  just  as  after  extirpation  of  the  thyroid,  there  is 
proliferation  of  neuroglia.  Through  destruction  of  the  nerve 
cells  those  mental  attributes  arise  that  are  deemed  typical  of  old 
age:  Egotism,  enmity  against  all  new  ideas,  conservatism,  etc., 
which  we  described  in  our  address  on  the  origin  of  crime  before 
the  Philadelphia  Medical  Jurisprudence  Society,  April  14,  1907.25 
The  same  mental  characteristics  are  also  typical  of  degenerated 
conditions  of  the  thyroid  and  pituitary  body,  as  we  have  seen 
in  a  case  of  acromegaly  whose  history  we  owe  to  Dr.  Dercum, 
of  Philadelphia. 

To  recapitulate,  we  may  state  that  old  age  is  caused  by 


25  Journal  of  the  Amer.  Med.  Assoc.,  May  17,  1907. 


The  Causation  of  Old  Age.  Ill 

degeneration  of  the  ductless  glands,  and  that  there  exists  a  con- 
dition of  auto-intoxication  in  old  age. 

The  symptoms  of  old  age  are  the  result  of  breakdown  of 
the  tissues  and  organs  which,  owing  to  shrinking  of  the  blood- 
vessels, are  insufficiently  supplied  with  blood,  and,  owing  to  the 
disappearance  of  nervous  elements,  are  devoid  of  proper  nervous 
control. 

Degeneration  of  the  ductless  glands  and  of  the  organs  and 
tissues  cannot  be  simultaneous,  for  the  latter  are  under  the  con- 
trol of  the  former.  These  glands  govern  the  processes  of  metabo- 
lism and  nutrition  of  the  tissues,  and  by  their  incessant  antitoxic 
action  protect  the  organism  from  the  numerous  poisonous  prod- 
ucts, be  they  of  exogenous  origin,  introduced  with  air  or  food, 
or  endogenous,  formed  as  waste  products  during  vital  processes. 
After  degeneration  of  these  glands  the  processes  of  metabolism 
in  the  tissues  are  diminished,  and  there  is  an  increase  of  fibrous 
tissue  at  the  expense  of  more  highly  differentiated  structures. 

The  fact  that  the  changes  in  the  tissues  are  secondary  and 
take  place  only  after  primary  changes  in  the  ductless  glands,  is 
best  proved  by  the  circumstance  that  they  can  be  produced,  either 
experimentally  by  the  extirpation  of  certain  of  the  ductless  glands, 
or  spontaneously  by  the  degeneration  of  these  glands  in  disease. 

Our  theory  as  to  the  causation  of  old  age  by  degeneration  of 
the  ductless  glands  has  been  confirmed  by  several  writers,  some 
of  whom  had  no  knowledge  of  our  existing  work. 

Thus  Campbell,  in  July,  1905,  published  a  short  note  in  the 
Lancet,  attributing  old  age  to  degeneration  of  the  ductless  glands, 
overlooking  our  previous  communication  to  the  Paris  Biological 
Society. 

Two  years  afterward  Pineles,  in  an  article  published  in  the 
Wiener  klin.  Wochenschrift,  comparing  the  origin  of  diabetes, 
tetany,  and  old  age,  came  to  the  conclusion  that  old  age  was 
caused  by  the  same  agency  {i.e.,  alteration  of  the  ductless  glands) 
as  the  other  conditions  mentioned. 

Sir  Herman  Weber,  in  his  interesting  work  on  the  prolonga- 


112  Old  Age  Deferred. 


tion  of  life,  also  attaches  great  importance  to  degeneration  of 
the  ductless  glands  as  a  cause  of  old  age. 

In  his  work  on  the  same  subject,  Professor  Metschnikoff 
admits,  only  partially,  the  truth  of  our  theory  on  the  causation 
of  old  age.  He  admits  the  great  importance  of  the  ductless 
glands  in  the  pathology  of  old  age,  as  they  serve  to  destroy 
poisons.  He  denies,  however,  the  relation  of  old  age  to  a 
myxcedematous  condition;  but  everyone  who  knows  the  pathol- 
ogy of  myxcedema  will  see  that  the  arguments  of  Professor 
Metschnikoff  cannot  stand,  for  they  have  no  foundation. 

His  arguments  are  that  there  is  an  oedema  in  myxcedema, 
but  not  necessarily  in  old  age;  that  the  hair  falls  out  in  myx- 
cedema, and  that  myxcedematous  women  have  abundant  men- 
struation, while  old  women  have  none ;  that  myxcedematous  per- 
sons have  strongly  developed  muscles,  and  old  people,  on  the 
contrary,  weak  and  feeble  muscles. 

The  truth  is  that  there  is  often  no  oedema  at  all  in  myx- 
cedema; that  the  hair  often  does  not  fall  out  in  myxcedema, 
especially  in  its  partial  form  (hypothyroidia)  ;  that  myxcedema- 
tous women  have,  as  a  rule,  no  menstruation  (atrophy  of  the 
ovaries)  ;  and  that  myxcedematous  people  have  not  a  strongly 
developed  muscular  system,  which  is  rather  degenerated  by  a 
new  growth  of  fat,  or  connective  tissue,  or  a  mucinous  tissue,  fol- 
lowing the  degeneration  of  the  thyroid  just  as  it  follows  its  extir- 
pation. Professor  Metschnikoff  also  states  that  certain  animals 
that  soon  become  old  do  not  develop  cachexia  after  extir- 
pation of  the  thyroid. 

This  was  the  belief  about  eighteen  years  ago,  but  now  we 
know  that  they  all  develop  cachexia  if  the  operation  is  so  per- 
formed that  the  parathyroids,  or  at  least  some  of  them,  are 
allowed  to  remain  untouched.  Professor  Metschnikoff's  views 
have  been  greatly  weakened  by  the  far  more  extensive  researches 
of  Professor  Sajous  which  have  conclusively  shown  that  the  life 
process,  its  activity  and  duration,  is  dependent  upon  the  ductless 
glands,  including  the  thyroid. 


The  Causation  of  Old  Age.  113 

It  is  evident  from  the  above  considerations  that  all  hygienic 
errors,  be  they  errors  of  diet  or  any  kind  of  excess,  will  bring 
about  their  own  punishment;  and  that  premature  old  age,  or  a 
shortened  life,  will  be  the  result.  In  fact,  it  is  mainly  our  own 
fault  if  we  become  senile  at  sixty  or  seventy,  and  die  before  ninety 
or  a  hundred. 

It  may  be  the  privilege  of  a  few  to  live  until  ninety,  even 
though  worshipping  immoderately  at  the  altars  of  Bacchus  or 
Venus !  But  these  are  very  few,  and  as  we  have  seen,  they  have 
lived  on  the  heritage  of  their  forefathers,  not  merely  in  an  illus- 
trative sense,  but  also  in  reality,  for  the  greater  number  of  such 
persons  have  grown  up  in  easy  circumstances  without  knowing 
the  wear  and  tear  of  care  and  sorrow. 

Not  only  old  age,  but  the  majority  of  diseases,  are  due  to 
our  own  fault  in  undermining  our  natural  immunity  against  infec- 
tions, and  subjecting  our  various  organs  to  unreasonable  over- 
work and  exertion.  We  do  not  believe  that  the  worst  slave- 
driver  of  olden  days  subjected  his  slaves  to  such  treatment  as 
we  do  our  own  organs,  and  especially  our  nerves.  At  last  they 
must  rebel,  and  disease,  with  early  death  or  premature  old  age, 
will  be  the  result. 

It  is  literally  true,  as  the  German  proverb  says :  "Jeder  ist 
seines  Gliickes  Schmied"  (every  man  is  the  locksmith  of  his  own 
happiness),  and  as  a  variation  on  this  we  would  say:  "Every  man 
is  the  guardian  of  his  own  health." 


CHAPTER  IX. 

The  Rational  Prevention  of  Premature  Old  Age  and 
the  Treatment  of  Old  Age. 

General  Remarks. 

We  have  shown  in  previous  chapters,  through  facts  from 
pathological  anatomy,  experimental  pathology,  and  clinical  medi- 
cine, that  old  age  is  a  disease  characterized  by  the  abundant 
growth  of  connective  tissue,  diminution  of  the  oxidations,  and 
a  condition  of  auto-intoxication. 

This  disease  is  caused  by  the  degeneration  of  the  glands  with 
internal  secretion,  especially  the  thyroid,  ovaries,  testicles,  liver, 
and  kidneys. 

In  the  same  way,  and  to  the  same  extent  as  most  other  dis- 
eases, this  disease  is  also  amenable  to  treatment,  although  a  thor- 
ough cure,  except  in  cases  beginning  in  very  early  years,  is  just 
as  little  possible  as  in  most  other  diseases. 

In  keeping  with  the  majority  of  diseases,  old  age  is  progres- 
sive, and,  in  fact,  is  so  to  a  far  higher  degree  than  other 
diseases.  It  is  seldom  stationary;  it  goes  on  all  the  time. 
This  we  shall  easily  be  brought  to  understand  from  the  fact 
that  the  more  time  progresses,  the  more  food  is  taken  to  sustain 
the  processes  of  life.  By  the  deficient  action  of  the  glands,  whose 
role  is  the  proper  assimilation  of  the  food  and  the  destruction 
and  elimination  of  poisonous  products  of  the  body,  these  toxic 
substances  will  accumulate,  day  by  day,  especially  if  meat  be 
taken,  and  thus  the  continual  poisoning  will  be  augmented  as 
time  goes  on.  Thus  it  must  be  our  most  important  task  to  check 
the  progress  of  a  condition  in  so  high  a  degree  injurious  to 
the  body. 

Let  us  consider  the  means  by  which  we  can  prevent  this 
(114) 


Prevention  of  Premature  Old  Age.  115 

disease,  for  "prevention  is  better  than  cure,"  says  the  English 
proverb. 

The  preventive  treatment  of  old  age  is  in  no  less  degree  pos- 
sible than  that  of  any  other  disease.  To  prevent  old  age  ration- 
ally, we  must  avoid  all  those  harmful  agencies  which  may  be 
deleterious  to  the  glands  with  internal  secretions,  as  it  is  the 
degeneration  of  these  glands  that  brings  it  about.  These  agen- 
cies, however,  being  exceedingly  numerous,  we  have  mentioned 
in  the  previous  chapter  only  those  which  are  in  the  highest  degree 
detrimental  and  also  the  most  frequent. 

By  avoiding  these  we  believe  we  could  successfully  combat 
old  age,  but  only  for  a  certain  time;  and  if  not  longer,  in  spite 
of  our  careful  hygiene,  it  would  not  be  our  fault,  but  that  of  our 
ancestors  of  many  generations  ago  who  did  not  observe  the  rules 
of  hygiene  even  as  well  as  we  do,  and  left  us  ductless  glands  of 
inferior  quality. 

Parents  can  only  bequeath  to  their  children  ductless  glands 
of  the  same  quality  as  they  themselves  possess.  This  undoubted 
fact  is  clearly  proved  by  the  experimental,  pathological,  and  ana- 
tomical results  we  have  mentioned  in  the  chapter  on  heredity. 
We  will  illustrate  this  by  the  following  examples,  which  will 
show  how  often  it  is  difficult  to  avoid  harmful  agencies,  and  how 
much  depends  on  having  been  born  with  healthy  ductless  glands. 

A  person  inhales  air  that  contains  virulent  bacilli  and  con- 
tracts tuberculosis.  Another  drinks  a  glass  of  water  or  milk, 
contaminated  by  water  or  kept  in  vessels  that  have  been  washed 
with  water  containing  the  bacilli  of  Eberth,  and  contracts  typhoid 
fever.  Conversely,  others  who  have  inhaled  the  same  air  and 
drunk  much  more  of  the  same  water,  have  remained  free  from 
any  infection. 

The  cause  of  this  is  that  the  first  mentioned  have  inherited 
defective  ductless  glands  from  their  ancestors,  and  probably  after- 
ward have  ill-treated  these  glands  by  an  immoderate  use  of  all 
those  agencies  that  are  detrimental  to  them,  such  as  alcohol, 
sexual  excesses,  much  meat,  tobacco,  tea  and  coffee  in  large  quan- 


116  Old  Age  Deferred. 


tities,  etc.,  and  thus  could  not  produce  anti-bodies  to  counteract 
the  infection. 

Of  course,  the  fault  does  not  lie  entirely  with  such  people, 
but  that  from  their  birth  they  are  the  victims  of  the  immoderation 
of  their  ancestors;  and  by  this  fact  alone  are  doomed  to  more 
easily  succumb  in  the  incessant  fight  against  the  microbes,  and 
therefore  a  limited  lifetime  has  been  already  meted  out  to  them 
at  birth. 

We  have,  in  the  chapter  on  heredity,  quoted  instances  of 
persons  coming  of  short-lived  families,  who  reached  a  great  old 
age ;  but  this  was  due  solely  to  exceedingly  careful  hygiene.  It 
is  not  always  easy  to  observe  these  rules  scrupulously,  and  besides 
often  necessitates  the  possession  of  means  to  carry  them  out  and 
to  enable  us  to  be  more  exempt  from  the  wear  and  tear  of  life — 
cares  and  sorrow, — which  shorten  the  lives  even  of  persons  with 
healthy  glands,  though  much  more  of  persons  who  have  inherited 
defective  ductless  glands. 

It  has  been  shown  by  statistics1  that  the  present  generation 
is  longer  lived,  and  that  the  average  of  life  is  longer,  than  was 
the  case  one  hundred  years  ago.  This  is  solely  due  to  the  fact 
that  now-a-days  we  know  more  of  hygiene  than  our  forefathers 
did,  although  the  struggle  for  existence  and  competition  every- 
where has  certainly  become  more  keen,  with  the  inevitable  worry 
and  depression  of  mind  which  it  so  frequently  brings  about.  This 
lengthened  life  is  certainly  due  to  more  careful  hygiene,  espe- 
cially against  infectious  diseases. 

The  extended  life  of  an  individual  depends  always,  first,  on 
the  inherited  qualities  of  the  ductless  glands,  and,  secondly,  on  a 
sound  observance  of  hygienic  measures. 

To  prevent  old  age  coming  on  too  soon,  the  first  condition 
necessary  is  the  possession  of  healthy  ductless  glands,  and  this 
will  depend,  as  just  stated,  on  heredity.  We  can  exert  no 
influence  on  the  generations  that  have  passed  away,  and  must 

l  Westergaard :      "Die    Lehre    von    der    Mortalitat    u.  Morbilitat,"  second 
edition,  Jena,  1901. 


Prevention  of  Premature  Old  Age.  117 

therefore  direct  all  our  attention  to  the  generations  that  are  to 
come.  This  can  only  be  done  by  influencing  the  laws  of  mar- 
riage, and  particularly  by  prohibiting  the  marriage  of  persons 
suffering  from  diseases  that  are  most  detrimental  to  the  glands 
with  internal  secretions. 

Children  of  people  suffering  from  syphilis,  tuberculosis, 
chronic  alcoholism,  etc.,  are,  as  we  have  seen,  born  with  con- 
genital atrophy  of  the  thyroid  gland,  and  are  especially  apt  to 
acquire  all  infectious  diseases,  such  as  tuberculosis,  with  the 
greatest  facility. 

The  Bible  is  literally  true  when  it  says  that  the  sins  of  the 
fathers  are  visited  even  unto  the  third  generation. 

Thus  we  can  influence  the  baby  even  before  it  is  born ;  let  us 
then  consider  what  we  can  do  after  its  birth  to  prevent  premature 
old  age  and  to  secure  for  it  a  prolonged  existence. 

The  mother  of  the  future  child  must  carefully  avoid  any- 
thing that  may  prove  fatal  to  the  foetus  or  influence  its  nutrition. 
It  is  a  well  demonstrated  fact  that  different  kinds  of  harmful 
products,  i.e.,  drugs  and  probably  also  stimulants  like  alcohol, 
coffee,  etc.,  can  be  conveyed  to  the  foetus.  A  pregnant  woman 
must,  therefore,  most  strictly  observe  all  the  rules  of  hygiene, 
and  especially  abstain  from  the  use  of  drugs  which  (as  for  in- 
stance, iodine,  the  bromides,  etc. )  can  also  take  effect  on  the  foetus 
and  prove  detrimental ;  emotions  must  especially  be  avoided. 

When  the  child  is  born  the  best  nutriment  for  the  baby  is 
the  milk  of  its  mother,  and  if  the  mother  be  not  available  for 
this  purpose,  a  wet  nurse  must  be  obtained,  for  human  milk  is 
indispensable  in  the  nourishment  of  the  baby  if  we  desire  to 
influence  its  future  immunity  against  infections ;  for  this  impor- 
tant purpose  all  the  internal  secretions  of  the  ductless  glands  go 
into  the  child  through  the  milk  which  contains  them.  Sajous 
holds  that  millions  of  infants  die  solely  because  they  are  deprived 
of  what  nature  provided  for  them,  the  maternal  milk,  which  not 
only  nourishes  them,  but  protects  them  against  disease. 

The  infant  is  practically  helpless  against  infections,  for  its 


118  Old  Age  Deferred. 


thyroid  contains  scarcely  any  colloid  substance,  sometimes  none ; 
and  it  also  contains  no  iodine,2  especially  in  children  who  are 
descended  from  parents  suffering  from  chronic  cachectic  diseases, 
such  as  tuberculosis,  syphilis,  malaria,  insanity,  etc.  The  other 
glands  are  also  not  yet  sufficiently  developed,  as  this  takes  place 
generally  in  the  years  toward  puberty. 

All  the  internal  secretions  will,  therefore,  come  to  the  chil- 
dren from  the  mother  or  wet  nurse. 

The  above  fact  also  explains  why  infectious  diseases  are  so 
very  frequent  among  infants,  and  also  among  children  before  the 
years  of  puberty. 

The  avoidance  of  infectious  diseases  is  especially  important 
for  infants,  for  in  later  life  many  other  infections  will  occur 
preferably  in  those  children  whose  ductless  glands  have  been 
weakened  by  previous  infection.  Therefore,  even  with  adults, 
when  we  take  the  history  of  a  case  we  should  inquire  whether,  in 
childhood  or  later,  the  patient  has  suffered  from  infectious  dis- 
eases. The  necessity  of  such  a  procedure  will  be  more  clear  after 
we  have  shown  their  relationship  with  a  weakening  of  the  ductless 
glands. 

The  possibility  of  premature  old  age  is  greater  in  a  person 
who  has  suffered  from  one  or  several  infectious  diseases  in  child- 
hood than  in  another  who  did  not  contract  any. 

Very  interesting  experiments  have  been  made  on  puppies 
fed  on  their  mothers'  milk,  and  some  with  raw  and  boiled  cows' 
milk,  showing  the  superiority  of  the  bitches'  milk,  and  also  of 
the  unboiled  milk. 

When  human  milk  is  not  available  for  divers  reasons,  fresh 
cow's  milk  should  be  employed,  using  it  raw,  however,  in  order 
not  to  destroy,  by  boiling,  various  substances  of  the  nature  of 
ferments.  Before  giving  it  to  the  baby,  the  cow's  milk  should  be 
diluted  with  water,  and  milk-sugar  and  cream  should  be  added  to 
make  it  more  like  human  milk  (see  Chapter  on  "Milk  Diet"). 


2  Baumann:     "Zeitschrift  fur  Physiolog.  Chemie,"  21,  319,  1895;  22,  1,  1896. 


Prevention  of  Premature  Old  Age.  119 

Of  course,  when  giving  raw  milk,  we  must  ascertain  that 
it  comes  from  cows  examined  specially  for  tuberculosis,  and  that 
the  milk  is  of  the  best  quality  and  very  fresh  since  it  has  been 
shown  that  its  power  to  kill  bacteria — and  therefore  to  protect 
the  child — begins  to  decrease  soon  after  it  is  drawn. 

Not  only  for  the  infant  in  arms,  but  for  the  growing  baby 
and  child  during  its  first  year,  milk  food,  containing  largely  of 
milk  and  cereals,  will  be  the  best  diet,  excluding  meat  entirely, 
since  in  these  tender  years  the  ductless  glands  are  not  sufficiently 
developed  to  destroy  poisonous  products  that  arise  from  the  end- 
products  of  decomposition  of  meat.  By  giving  these  little  creat- 
ures meat  we  may  depreciate  the  efficiency  of  their  ductless 
glands  through  unnecessary  strain  in  the  destruction  of  poisons, 
and  thus  diminish  their  chances  in  later  life,  of  a  prolongation  of 
youth  and  a  happy  old  age.  For  the  same  reasons  and  even 
more  weighty  ones,  alcohol,  coffee,  tea,  etc.,  should  be  avoided. 

It  is  sad  to  reflect  that,  in  some  countries,  alcohol  is  given  to 
children,  who  are  even  far  more  helpless  against  it  than  adults. 

We  have  observed  in  Northern  Hungary  that  the  children  of 
the  Slovacks,  a  Slav  nation  that  inhabits  certain  parts  of  Hun- 
gary— the  native  land  of  the  writer, — are  stunted  in  their  growth. 
The  reason  for  this  is,  that  in  these  parts  of  Hungary,  where  there 
are  plenty  of  potatoes,  but  a  scarcity  of  other  food,  the  peas- 
ants give  brandy  to  their  youngsters.  As  we  have  seen  in  the 
second  chapter  of  this  book,  the  growth  of  the  human  body 
depends  on  the  thyroid  gland.  The  fact  that  these  children  do 
not  grow  shows  that  alcohol  is  deleterious  to  the  thyroid.  This 
question  will  be  considered  more  fully  in  the  chapter  on  alcohol. 
The  advantages  of  milk  food  we  shall  also  treat  more  fully 
in  a  separate  chapter. 

To  deal  with  old  age  rationally,  we  must  begin  in 
childhood  to  fight  against  it,  as  all  those  agencies  that  tend  to 
produce  it  prematurely  can  at  this  age  prove  far  more  deleterious; 
and  as  in  this  world  no  action  is  lost — whether  for  good  or  evil — 
we  must  reap  the  results  of  our  imprudence  in  later  life. 


120  Old  Age  Deferred. 


Unhappily  at  this  tender  age  we  have  no  reasoning  powers, 
the  glands  governing  them  not  having  been  developed,  and  there- 
fore our  parents  or  guardians  must  act  for  us.  Their  want  must 
also  be  supplied  by  the  teacher,  and  we  believe  it  would  be  produc- 
tive of  great  good  to  teach  the  elementary  rules  of  hygiene  in 
school  at  the  same  time  as  reading  and  writing. 

The  impressions  we  first  get  in  childhood  remain  through- 
out life  and  are  never  forgotten;  therefore,  hygiene  should  be 
learned  even  by  small  children.  The  soul  of  a  child  is  like  plaster 
of  Paris,  that  can,  like  dough,  be  moulded  into  any  shape  we 
desire.  It  is  at  this  early  age  that  we  should  learn  of  the  necessity 
of  a  bath  every  day,  of  moderation  in  food,  the  avoidance  of 
certain  stimulants,  such  as  alcohol,  and  also  of  tea  and  coffee  in 
large  quantities. 

Alcohol,  coffee,  and  tea  are  especially  injurious  to  children. 
The  celebrated  German  clinician,  Striimpell,  writes  as  follows  in 
the  Pedagogical  Pathology:  "Among  the  acute  as  well  as  chronic 
intoxications — which  can  be  the  cause  not  only  of  a  temporary, 
but  also  of  a  prolonged  psychopathic  condition, — intoxication  by 
alcohol,  and  by  stimulants  generally,  plays  the  greatest  role. 
Such  abuse  is  especially  noxious  to  children,  and  causes  an  enor- 
mous number  of  diseases  with  psychopathic  results."  We  our- 
selves believe  that  it  is  a  crime  to  give  alcohol  to  children,  and 
that  it  should  be  punishable  as  such. 

Dr.  F.  Heyn,  in  a  statistical  contribution  on  "Idiocy,"  that 
appeared  recently  in  the  Psychiatrisch  N eurolo gische  Wochen- 
schrift,  showed  that  in  17.6  per  cent,  of  cases  of  idiocy  in  children 
the  above  mentioned  fault  in  hygiene — the  use  of  alcohol,  tea,  and 
coffee — was  the  cause.  Thirteen  years  ago  Director  Triiper,  in 
a  monograph  on  the  psychopathic  conditions  of  childhood,  insisted 
on  abstinence  not  only  from  alcohol,  but  also  from  coffee,  by 
women  during  pregnancy ;  but  it  should  be  noted  also  that  these 
agencies  continue  to  be  deleterious  years  after  a  child  is  born. 

Above  all  else  we  must  try  to  make  a  good  man  or  woman 
of  the  child,  as  this  also  is  an  essential  safeguard  against  dis- 


Prevention  of  Premature  Old  Age.  121 

ease  and  premature  old  age.  We  should  endeavor  to  interest 
children  while  they  are  yet  of  a  school  age  in  the  fine  arts,  such  as 
music,  painting,  and  literature,  as  they  have  a  very  favorable 
influence  on  the  hygiene  of  the  mind  in  after  years.  Religious 
instruction  also  gives  good  results  in  this  respect. 

'When  children  approach  puberty  it  is  important  to  avoid 
an  agency  that  may  prove  very  deleterious  to  certain  of  the  glands 
with  internal  secretions,  and  this  is  masturbation. 

We  will  not  commit  the  error  made  by  so  many  unscientific 
writers  of  ascribing  much  greater  importance  to  this  matter 
than  it  deserves.  It  certainly  is  not  true  that  tabes  dorsalis, 
dementia  paralytica,  or  other  serious  nervous  diseases  will  result 
from  this  source;  but  it  cannot  be  denied  that  neurasthenia  or 
hysteria  or  impotency — sexual  neurasthenia — can  be  promoted 
by  the  exaggeration  of  masturbation,  if  indulged  in  many  years. 
Masturbation  is  always  injurious  to  the  sexual  glands,  more 
so  to  the  male  than  to  the  female  organs,  and  in  addition  to  the 
thyroid,  and — if  in  excess — to  the  adrenals.  It  also  very  un- 
favorably influences  the  mind  and  character. 

In  youth,  instruction  as  to  the  control  of  the  sexual  passions 
will  be  of  the  utmost  importance,  even  considering  alone  the 
dangers  of  infections,  especially  of  gonorrhoea,  which  not  only 
endangers  the  future  husband,  but  the  future  wife  also.  We  need 
here  but  mention  the  well-known  fact  that  the  thorough  and 
radical  cure  of  syphilis  may  even  more  readily  be  accomplished 
than  that  of  chronic  gonorrhoea. 

We  have  mentioned  above  that  after  gonorrhoea  (every 
chronic  gonorrhoea  involves  the  prostate  gland)  there  are  severe 
disturbances  of  the  nervous  system,  which  may  also  influence  the 
mind,  causing  hypochondria. 

To  prevent  all  these  dangers  there  has  been  formed  in 
France  a  society  called  "Societe  Franchise  de  Prophylaxie  Sani- 
taire  et  Morale,"  which  advocates  the  necessity  of  instructing 
boys  and  girls  as  to  all  the  dangers  that  threaten  them  and  how 
to  avoid  them. 


122  Old  Age  Deferred. 


Happy  is  the  young  man  who  is  able  to  live  in  perfect 
chastity  without  harm  to  mind  or  body.  We  will  enter  more 
fully  into  the  consequences  of  complete  sexual  abstinence  in  the 
chapter  on  sexual  hygiene;  but  the  great  majority  of  young  men 
have  the  danger  from  sexual  intercourse  suspended,  as  the  sword 
of  Damocles,  over  their  heads,  and  the  best  way  to  avoid  this  is 
by  marriage. 

Marriage  is,  indeed,  an  invaluable  aid  in  the  struggle  against 
old  age;  but  sometimes,  although  this  is  an  exception,  it  may 
turn  out  to  be  a  double-edged  sword. 

By  marriage  a  young  man  acquires  regular  habits,  and  by 
the  assistance  of  a  loving  wife  is  better  able  to  control  his  pas- 
sions; and  last,  but  not  least,  the  hygiene  of  the  mind  will  also 
be  improved.     The  inevitable  hardships  of  life  are  thus  less  felt. 

These  great  advantages  of  marriage  can,  however,  exist 
only  in  cases  where  the  two  halves  make  one  whole — i.e.,  where 
the  sun  of  happiness  shines  in  the  marital  sky.  For  this  purpose 
each  of  these  two  halves  must  endeavor  best  to  please  the  other. 
The  husband  must,  as  is  quite  in  the  nature  of  things,  show  the 
utmost  forbearance  to  the  wife,  and  never  forget  that,  on  account 
of  her  different  anatomical  and  physiological  constitution,  the 
mind  of  the  female  is  far  more  exposed  to  frequent  irritation  as  a 
natural  consequence  of  the  frequent-  alterations  of  the  sexual 
glands  and  thyroid  in  women.  It  would  be  unreasonable  to 
blame  her  for  a  condition  for  which  not  the  woman,  but  her 
Maker,  is  responsible. 

If  married  life  is  one  of  the  best  means  to  defer  old  age, 
on  the  other  hand  it  is  positively  certain  that  unhappy  marriages 
are  the  surest  means  to  hasten  its  oncoming;  but  these  are  the 
exception,  and,  as  in  everything  else,  the  exception  only  proves  the 
rule. 

A  single  man,  or  woman,  is  far  more  exposed  to  all  the 
agencies  we  have  referred  to  above  as  being  deleterious  in  caus- 
ing old  age  and  especially  depressed  conditions  of  the  mind,  these 
being  the   consequences   of   total   sexual   abstinence,    faults   of 


Prevention  of  Premature  Old  Age.  123 

hygiene  in  diet,  use  of  stimulants  (alcohol  in  men,  coffee,  tea, 
etc.,  in  women),  fewer  precautions  against  disease,  and  so  many 
other  agencies  of  less  importance  that  there  can  be  no  doubt  that 
the  bachelor  or  spinster,  as  a  rule,  will  become  old  in  earlier  years 
than  the  married  person.  Therefore,  although  himself  still  a 
bachelor,  the  writer  feels  compelled  to  sing  the  praises  of  married 
life  as  a  hygienic  factor  favoring  old  age. 

The  possession  of  children  is  heavenly  bliss  to  married  peo- 
ple, and  their  pride  and  joy  in  them,  and  in  living  with  youngsters, 
renders  the  parents  young,  as  the  German  proverb  says.  But  as 
every  good  thing,  if  in  excess,  may  turn  out  to  be  harmful,  omne 
quod  est  nimium  vertitur  in  vitima,  so  too,  many  pregnancies  may 
prove  very  harmful  in  the  fight  against  old  age,  especially  when 
the  mother  nurses  for  a  long  period  each  of  the  children.  In 
women  who  produce  much  milk  this  may  prove  advantageous  to 
health  if  not  too  greatly  prolonged ;  but  in  women  with  a  meager 
provision  of  milk — as  in  cases  of  thyroid  insufficiency — it  may 
prove  disastrous  by  destroying  the  means  of  keeping  youthful  till 
an  advanced  period. 

In  married  women  with  many  pregnancies  much  will  depend 
on  external  circumstances  of  life,  and  it  is  certain  that  nothing 
will  hasten  the  advance  of  old  age  as  many  pregnancies,  the 
mother  suckling  all  the  children  herself,  in  combination  with  defi- 
cient food,  the  wear  and  tear  of  poverty,  and  with  anxiety  as  to 
the  morrow.  This  cruel  struggle  for  daily  bread  is  what  renders 
the  women  of  the  lower  classes  old  before  their  youth  has  passed. 

To  prevent  the  deleterious  consequences  of  too  many  preg- 
nancies on  beauty,  health,  and  wealth,  in  certain  countries,  as  in 
France,  the  habit  of  having  one  or  two  children  has  been  encour- 
aged by  artificial  means.  However,  as  is  always  the  case  when 
our  acts  disregard  Nature,  great  mischief  may  thus  arise,  and 
even  in  cases  where  death  has  not  followed  abortions,  very  often 
such  irreparable  damage  is  caused  to  the  organs  on  which  youth 
and  beauty  depend  that  the  oncoming  of  old  age  is  still  further 
hastened. 


124  Old  Age  Deferred. 


The  endometritis  and  peri-  and  parametritis  of  many  years 
duration,  which  are  sometimes  the  result  of  such  procedures, 
influence  the  appearance  of  these  persons  more  unfavorably  than 
many  pregnancies. 

Parents  who  have  many  children  may  be  regarded  as  the 
happiest  of  mankind.  Their  name  is  forever  perpetuated  through 
their  numerous  sons,  and  their  flesh  and  blood  survives  in  their 
children,  to  quote  the  great  German  philosopher,  Schopenhauer. 

The  years  of  the  climacteric  are  the  most  troublesome  in  mar- 
ried life,  not  only  for  the  wife,  w!k>  is  directly  affected  by  it,  but 
also  in  almost  equal  degree  for  the  husband,  who  must  show  the 
greatest  forbearance  to  his  wife  at  this  period.  The  sun  is  set- 
ting! It  is  not  merely  that  the  decline  of  the  sexual  functions 
produces  certain  changes  in  the  body,  which  are  especially  notice- 
able in  the  external  appearance;  the  influence  on  the  mind  also 
produces  deleterious  effects.  Therefore  we  must  direct  all  our  at- 
tention to  the  hygiene  of  the  mind.  In  married  women  with  lov- 
ing husbands  and  children  the  task  will  be  much  facilitated.  As 
we  have  already  mentioned,  this  stage  of  human  life  is  most  felt 
by  professional  beauties,  who  witness  with  chagrin  the  vanishing 
of  their  power  over  the  hearts  of  men.  In  many  spinsters  living 
alone,  friendless,  this  is  also  a  frightful  stage  of  life.  Here  we 
have  again  an  opportunity  to  observe  the  wonderful  soothing 
effects  of  religion,  which  offers  us  consolation  in  all  our  troubles. 
Religious  women  will,  therefore,  much  better  withstand  this  most 
difficult  part  of  their  life.  Religion  and  philosophy,  too,  may  be 
still  more  helpful  to  overcome  mental  depression. 

It  is  interesting  to  note  that  many  women,  even  those  pre- 
viously little  given  to  religious  practices,  turn  over  a  new  leaf, 
and  to  make  up  lost  ground,  become  quite  pious.  Such  as  in 
their  youth  were  haughty  and  proud  beauties,  and  only  went  to 
church  to  exhibit  their  new  hats  and  toilette,  now  become  meek 
and  modest,  and  never  miss  a  religious  meeting  or  exercise. 

■    Still,    even    after    a    woman    has    passed    the    climacteric, 
everything  is  not  lost  if  only  she  be  a  clever  member  of  her  sex. 


Prevention  of  Premature  Old  Age.  125 

In  fact,  something  remains  that  may  even  place  her  above  her 
much  younger  sisters,  and  that  is  experience  and  knowledge  of 
the  world ;  and  if,  by  the  aid  of  a  skillful  toilette,  she  is  able  to 
make  the  best  of  what  good  looks  remain  from  better  days,  it  is 
probable  that  she  will  outdo  many  of  her  sisters  far  below  her 
in  age. 

Even  if  at  this  time  of  her  life,  aware  of  the  approach  of 
old  age  and  its  cruelties,  she  may  be  inclined  to  say  with  Long- 
fellow, "but  the  hopes  of  youth  fall  thick  in  the  blast,"  still  there 
are,  in  the  present  state  of  science,  plenty  of  resources  open  to 
her,  no  less  than  to  a  man,  to  put  off  old  age  for  a  score  of  years, 
or  to  mitigate  its  effects  when  it  has  asserted  itself  with  all  its 
terrors. 

We  owe  our  knowledge  of  the  fact  that  there  is  a  treatment 
for  old  age  to  the  famous  French  scientist,  Professor  Brown- 
Sequard,  whose  father  was  American  and  who,  for  a  time,  was 
professor  of  physiology  at  Harvard  and  later  a  practitioner  in 
New  York  which  he  left  to  become  professor  of  physiology  at  the 
University  of  Paris.  Although,  before  him,  Claude  Bernard,  a 
man  of  no  less  fame,  had  shown  the  existence  of  internal  secre- 
tions, Brown-Sequard  was  the  first  to  draw  practical  conclusions 
from  this  fact,  and  the  first  who  gave  a  solid  basis  to  the  doctrine 
of  internal  secretion. 

Brown-Sequard  was  the  first  to  use  the  extracts  of  a  duct- 
less gland  (the  testicle)  for  therapeutic  purposes,  although  thou- 
sands of  years  before  him  the  Chinese  had  used  different  organs 
for  purposes  of  healing,  and  the  savages  of  Africa  ate  certain 
portions  of  their  enemies — the  liver  and  the  testicles — to  enhance 
their  own  courage. 

Brown-Sequard  obtained  surprising  results  by  using  the 
crushed  extracts  of  rabbits,  guinea  pigs,  and  dogs,  of  which  we 
will  say  more  in  the  chapter  on  the  prevention  and  treatment 
of  old  age  by  organic  extracts. 

Unhappily,  as  human  nature  is  prone  to  attack  every  inno- 
vation or  to  ridicule  it,  in  spite  of  the  great  reputation  of  this 


126  Old  Age  Deferred. 


savant,  his  discoveries  were  skeptically  received;  and  if  the 
extracts  of  another  similar  gland — the  thyroid — had  not  yielded 
such  marvelous  results,  probably  the  author  of  the  present  work 
would  never  have  had  the  opportunity  to  write  on  the  treatment 
of  old  age  with  organic  extracts. 

It  has  been  shown  by  many  authorities  that  the  thyroid 
gland  is  able — as  we  have  already  mentioned  several  times  in 
different  parts  of  this  book — to  augment  the  processes  of  oxida- 
tion, and  it  has  also  been  stated  by  several  authorities,  such  as 
George  Murray,  Vermehren,  Hertoghe,  and  Laache,  that  persons 
treated  with  thyroid  extracts  appear  much  younger  after  the 
treatment — sometimes,  as  Hertoghe  mentions,  ten  to  twenty 
years  younger. 

Now,  if  a  person  suffering  from  complete  myxcedema  can 
obtain  such  a  result  by  the  use  of  thyroid  extracts,  should  not  a 
person  suffering  only  from  a  partial  form  of  the  same  disease 
be  able  to  obtain  similar  results  ?  It  would  be  quite  contrary  to 
our  physiological  conceptions  that  a  person  in  a  bad  condition 
of  health  and  in  physiologically  inferior  circumstances  should 
benefit  more,  by  exactly  the  same  treatment,  than  another  person 
who  is  in  a  much  better  condition  of  health.  Therefore,  the 
thyroid  treatment  of  old  age  is  justified.  And  indeed,  we  our- 
selves have  seen  astonishing  results  from  thyroid  treatment,  not 
only  in  old  people,  but  also  in  persons  under  40. 

Thus  the  thyroid  can  be  of  valuable  aid  for  the  prevention 
of  old  age,  and  for  deferring  its  onset  as  long  as  possible ;  and  for 
this  purpose  it  will  be  necessary  to  begin  our  treatment  in  women 
at  about  the  age  of  35,  or  in  certain  cases,  such  as  where  many 
pregnancies  have  occurred,  even  before  this  age,  and  in  men  at 
some  time  after  40  (see  also  Chapter  LIII).  Still,  to  avoid  abuses 
in  the  use  of  this  efficient  drug,  it  would  be  necessary  to  pass  a 
law  prohibiting  its  sale  without  a  medical  prescription. 

Besides  the  thyroid  gland,  the  extracts  of  the  sexual  glands 
can  also  be  used ;  thus,  ovarian  extracts  for  women,  and  testicular 
extracts  for  men. 


Prevention  of  Premature  Old  Age.  127 

We  have  also  witnessed  good  results  with  ovarian  and  tes- 
ticular extracts  of  pigs.  Long  before  ourselves,  Brown-Sequard 
and  Professor  von  Poehl  and  many  others  made  very  interesting 
observations  on  testicular  extract,  on  which  we  shall  dwell  in  the 
chapter  on  the  treatment  with  testicular  extracts. 

Besides  the  above  extracts,  those  of  the  kidneys  and  of  the 
pancreas  have  also  given  us,  and  others,  very  good  results,  and 
they  can  be  used  with  advantage  in  the  prevention  and  rational 
treatment  of  old  age  in  combination  with  the  other  extracts, 
though  preferably  in  cases  where  the  functions  of  these  organs 
are  deficient.  In  old  age  that  has  already  become  manifest 
they  should  always  be  used,  as  they  will  facilitate  the  work  of 
these  very  important  organs,  and  thus  prolong  their  vitality.  In 
this  manner  an  old  man  will  be  able  to  employ  these  organic 
extracts  of  the  pig  to  work  for  the  benefit  of  his  own  organs,  or, 
at  any  rate,  to  assist  in  their  work. 

We  have  given  above  a  sketch  of  the  dangers  that  follow 
us  from  the  cradle  until  old  age,  and  hasten  its  arrival,  and  shown 
by  what  means  we  can  avoid  or  diminish  them  in  the  different 
stages  of  life;  we  would  now  like  to  offer  a  few  hints  that 
may  prove  useful  for  any  of  these  periods  in  life. 

We  have  shown  in  the  previous  chapters  that  the  degenera- 
tion of  certain  glands  with  internal  secretions,  especially  the  thy- 
roid, liver,  and  kidneys,  will  produce  a  condition  of  auto-intoxi- 
cation, as  poisonous  products  will  not  be  destroyed  in  the  proper 
manner,  and  also  not  eliminated  from  the  body.  Therefore  our 
whole  energy  must  be  turned  to  working  in  time  against  this  auto- 
intoxication of  the  body.  This  can  be  most  rationally  done  by 
a  careful  hygiene  of  these  different  ductless  glands — into  which 
we  will  enter  later  in  separate  chapters — and  also  by  special 
cultivation  of  the  functional  efficiency  of  those  organs  that 
eliminate  poisonous  products  from  the  body,  such  as  the  kidneys, 
intestines,  and  the  skin. 

These  three  organs  are  in  close  relation  to  each  other,  for 
when  one  is  threatened  the  others  come  to  its  assistance  and 


128  Old  Age  Deferred. 


aid  it  in  the  work  of  elimination.  Thus,  when  the  kidneys  are 
not  functionating-  as  they  should,  the  skin  comes  to  the  rescue 
and  helps  to  eliminate  a  large  part  of  the  remaining  products  by 
increased  perspiration.  Nature  often  does  this  spontaneously 
before-  we  come  to  her  aid. 

The  intestines  will  do  their  best,  in  like  manner,  to  expel  a 
part  of  these  products.  Recognizing  this  co-operative  action  of 
almighty  Nature,  we  must  also  try  to  be  of  assistance  by  careful 
hygiene,  and  later  on  we  shall  see  what  will  be  the  best  way  to 
effect  this;  but  let  us  at  once  urge  here  that  the  necessity  of 
having  the  bowels  moved  daily  should  be  insisted  on  from  earliest 
childhood.  Especially  is  this  of  the  greatest  importance  in  the 
case  of  young  girls,  for  with  them  this  most  necessary  rule  of 
hygiene  is  so  often  neglected.  There  is  no  doubt  that,  in  many 
persons,  fsecal  matter  can  stagnate  in  the  intestines  for  a  few 
days  without  much  consequence,  as  the  epithelium  of  the  intes- 
tines, when  in  sound  condition,  may  prevent  the  entrance  of 
poisonous  products.  But  it  may  be  different  when  this  becomes 
a  habit;  and  when  the  epithelium  is  not  in  perfect  order, — as  is 
often  the  case  after  prolonged  constipation,  or  with  catarrhs  of 
any  kind,  or  with  excreta  which  by  their  shape  may  injure 
the  epithelium  mechanically, — resorption  will  follow. 

At  any  rate,  it  is  an  every  day  occurrence  for  persons  who 
have  not  had  their  bowels  moved,  even  for  one  day,  to  complain 
of  headache  and  other  symptoms  of  uneasiness,  so  that  it  is 
impossible  to  regard  these  as  simple  reflex  actions,  as  some  are 
disposed  to  think,  but  rather  as  symptoms  of  auto-intoxication. 
Therefore  the  necessity  of  clearing  the  bowels  every  day  should 
be  insisted  on,  and  again  especially  in  the  case  of  the  young 
girls,  for  it  can  easily  become  a  bad  habit  once  they  have  begun  to 
neglect  it,  and  the  sluggishness  of  the  bowels,  to  which  females 
have  a  peculiar  tendency,  is  thus  further  encouraged. 

Everything  should  be  done  to  prevent  habitual  constipation 
in  young  girls,  for  the  important  reason  that  stagnation  of 
blood  in  the  adjacent  organs  of  the  pelvis  is  otherwise  promoted, 


Prevention  of  Premature  Old  Age.  129 

and  thereby  also  a  tendency  to  subsequent  diseases  of  the 
sexual  organs,  from  which  many  women  suffer,  at  any  rate  much 
more  frequently  than  men. 

This  movement  of  the  bowels  every  day  can  best  be  secured 
by  appropriate  food,  such  as  exercises  a  gently  stimulating  action 
on  the  walls  of  the  bowels.  Drugs  should  be  avoided  as  much 
as  possible,  for  reasons  we  will  mention  in  another  chapter. 

Habitual  constipation,  if  persisting  for  years,  can  certainly 
facilitate  the  oncoming  of  old  age,  while  its  appearance  can  be 
considerably  deferred  by  a  good  movement  every  day,  owing  to 
the  prompt  release  from  the  organism  of  a  mass  of  toxic  products. 

The  great  importance  of  this  can  be  easily  realized  if  we 
observe  the  face  of  any  one  who  has  been  constipated  for  several 
days.  After  a  thorough  clearing  out,  the  face  becomes  fresher 
and  the  eyes  brighter.  The  complexion  that  was  previously  a 
dirty  gray  becomes  white  and  rosy  again,  particularly  in  the  case 
of  young  women.  Should  not  this  prove  an  object  lesson  as  to 
the  vital  importance  of  a  thorough  evacuation  daily  as  a  safeguard 
against  premature  old  age? 

Every  physician  who  practices  in  a  place  where  the  mineral 
waters  have  purging  effects  has  occasion  to  observe  that  persons 
coming  to  these  spas,  looking  worn  out  and  gray  in  the  face, 
with  pendant  cheeks,  and  showing  all  the  signs  of  auto-intoxi- 
cation from  the  retention  of  poisonous  products,  always  look 
much  fresher,  and,  indeed,  many  years  younger,  after  the  cure. 
We  could  observe  the  same  effects  in  our  own  case  after  each 
purge,  although  we  do  not  suffer  from  habitual  constipation. 

There  is  no  doubt  that  freedom  from  occupation,  and  par- 
ticularly life  in  the  open  air,  in  the  woods  and  meadows,  have 
a  very  great  influence  in  effecting  such  cures ;  but  we  may  note 
the  same  effects  after  courses  of  purging  without  the  aid  of  such 
conditions  as  the  above. 

The  care,  not  only  of  the  bowels,  but  of  the  skin,  must  be 
impressed  on  every  one  from  earliest  childhood,  especially  the 
necessity  of  a  bath  daily.     Unfortunately,  this  is  too  much  neg- 


130  Old  Age  Deferred. 


lected  on  the  Continent,  and  becomes  prevalent  only  as  Anglo- 
Saxon  customs  are  diffused  abroad. 

By  a  bath  with  soap  the  pores  of  the  skin  are  better  opened, 
as  the  dirt  that  clogs  them  is  removed,  and  thus  the  poisonous 
products  can  be  given  off  through  the  skin  more  easily,  and  the 
skin  thereby  justifies  its  name  as  chief  assistant  to  the  kidneys. 
It  is,  in  fact,  our  second  kidney.  When  the  skin  comes  into 
greater  activity  through  the  action  of  the  sudorific  glands,  a  part 
of  the  solids  in  the  urine  and  many  harmful  matters,  which  other- 
wise would  make  their  way  through  the  kidneys,  are  eliminated 
through  the  skin  instead,  in  which  manner  the  powers  of  the  kid- 
neys are  economized. 

It  is,  therefore,  only  natural  that  we  should  do  everything 
to  promote  these  important  functions,  especially  since  we  may 
regard  the  skin  not  only  as  a  second  kidney,  but  to  a  certain 
extent  also  as  a  second  lung;  for  it  possesses  respiratory  func- 
tions in  addition,  receiving  oxygen  and  giving  off  carbonic  acid 
to  a  certain  degree. 

To  assist  these  functions  in  every  possible  way,  we  must 
allow  the  air  to  reach  the  skin  freely,  for  which  purpose  cloth- 
ing and  underwear  should  be  porous,  in  order  not  to  impede  the 
process  of  respiration  and  elimination.  This  end  will  also  be 
attained  by  exercise  in  the  open  air  and  sunshine;  in  fact,  by 
remaining  out-of-doors  as  long  as  possible.  All  these  important 
features  will  be  dealt  with  fully  in  separate  chapters. 

Before  leaving  the  subject  of  the  prevention  and  rational 
treatment  of  old  age,  we  will  give  a  few  hints  that  may  be  of 
use  in  any  stage  of  life. 

First,  great  moderation  in  the  diet  should  be  observed,  as 
large  quantities  of  food  may,  in  the  long  run,  impair  the  powers 
of  the  digestive  organs,  and  also  of  several  of  the  ductless  glands, 
which  are  concerned  in  the  operations  of  digestion  and  assimila- 
tion— the  pancreas  and  liver.  Sajous  has  shown  that  the  secre- 
tion of  the  adrenals  takes  actual  part  in  the  functions  of  all  these 
organs.     Everything  that  is  eaten  should  be  thoroughly  masti- 


Prevention  of  Premature  Old  Age.  I'll 

cated  and  not  "bolted" ;  digestion,  in  reality,  beginning  in  the 
mouth. 

Meat  should  not  be  consumed  in  large  quantities,  as  it  is 
injurious  to  various  glands  with  internal  secretions,  especially  the 
thyroid  and  liver,  and  after  having  been  taken  for  a  long  time 
in  large  quantities  can  promote  arteriosclerosis  (see  Chapter 
XVI). 

The  best  nourishment  for  increasing  the  chances  of  a  long 
life  and  to  defer  the  effects  of  old  age,  is  a  diet  consisting  of  little 
meat,  much  milk,  and  vegetables.  We  have  for  many  weeks 
lived  on  a  diet  consisting  solely  of  milk,  eggs,  bread,  butter,  and 
fruits,  and,  we  believe,  have  never  felt  so  fresh  and  well  dis- 
posed to  work  as  during  that  time  and,  as  friends  remarked,  never 
looked  so  well,  either. 

A  strictly  vegetarian  diet,  without  milk  and  eggs,  is  distinctly 
unwise  and  dangerous  to  health,  if  followed  for  a  long  time. 
Our  anatomical  and  physiological  construction  is  not  adapted  to 
such  nourishment  (see  the  chapter  on  this  subject). 

By  many  authorities  wine  is  called  "the  milk  of  old  age." 
This  is  not  true,  although  it  is  a  fact  that  many  old  people  feel 
better  after  an  occasional  glass  of  claret,  when  they  have  been 
in  the  habit  of  taking  it  for  years. 

We  will  deal  with  alcohol  and  its  deleterious  effects  in  a 
separate  chapter.  Far  more  injurious  than  red  wine  used  in 
moderation,  are  tea  and  coffee  used  in  large  quantities.  Unfor- 
tunately, many  of  those  who  fanatically  fight  against  alcohol,  in- 
dulge in  many  cups  of  black  coffee  or  tea  daily,  and  thus  poison 
their  nervous  system.  Besides  containing  thein  and  caffein,  they 
also  aid  the  formation  of  uric  acid,  as  they  contain  bodies  from 
which  the  purin  substances  are  produced  (Haig,  Hutchison, 
Walker  Hall). 

Cocoa  and  chocolate  may  be  taken  in  larger  quantities  than 
coffee  or  tea.  Cocoa  with  milk  is,  at  the  same  time,  very  nutri- 
tious, as  it  contains  fatty  substances. 

Spices  should  be  avoided  as  much  as  possible,   especially 


132  Old  Age  Deferred. 


sharp,  irritating  condiments,  which  are  so  freely  taken,  particu- 
larly in  America. 

We  must  not  forget  that  the  greater  part  of  all  we  eat  and 
drink  must  pass  through  the  kidneys,  the  fine  epithelium  of  which 
is  thus  easily  endangered.  For  the  same  reason-  drugs  should 
only  be  taken  under  medical  advice,  and  with  great  reserve,  for 
if  taken  too  freely  they  may  not  only  injure  the  kidneys  and  liver, 
but  also  the  stomach,  which  first  receives  them. 

Sound  sleep  is  of  the  greatest  importance.  Most  of  the 
organs  rest  during  sleep ;  the  great  brain  in  particular  being  com- 
pletely at  rest;  but  the  disintoxicating  glands  are  most  active 
during  sleep.  This  function  should  therefore  be  promoted  by 
all  means,  and  we  shall  devote  a  special  chapter  to  sleep,  its  causa- 
tion, and  the  treatment  of  insomnia.  Let  us,  however,  at  once 
mention  that  sleep  can  best  be  encouraged  by  the  use  of  a  large, 
airy  room,  and  going  to  bed  early,  say,  at  ten  to  half-past,  and 
rising  at  five  or  half-past,  when  sleep  has  been  undisturbed  during 
the  night.  Seven  hours'  sleep  is  the  best;  longer  sleep,  if  over 
seven  and  one-half  or  eight  hours,  injurious,  except  for  anaemic 
girls  and  women.  Many  people  do  very  well  with  six  hours' 
sleep,  but  less  than  this  will  prove  injurious  in  the  long  run. 

It  is  astonishing  to  note  the  large  proportion  of  persons  liv- 
ing to  a  very  great  age  that  were  early  risers ;  for  which  reason 
we  may  conclude  that  "early  to  bed  and  early  to  rise"  is  a  valu- 
able factor  in  the  struggle  against  old  age. 

We  emphatically  repeat,  over  and  over  again,  the  impor- 
tance of  fighting  against  our  passions  and  cultivating  the  hygiene 
of  the  mind;  this  must  be  commenced  in  early  childhood  and 
continued  through  life;  and  the  good  qualities  of  the  mind, 
which  we  will  call  the  "positive"  features  of  the  mind,  should 
be  especially  cultivated,  such  as  kindness,  good-heartedness, 
friendship,  love,  magnanimity,  hope,  modesty,  liberality,  gener- 
osity, frugality,  and  above  all  things,  contentment  with  every- 
thing. On  the  other  hand  we  may  describe  wickedness,  unfriend- 
liness, hatred,  and  jealousy  as  "negative"  features  of  the  mind, 


Prevention  of  Premature  Old  Age.  133 

which  should  be  smothered  at  their  very  inception  in  the  child. 

The  most  successful  way  to  fight,  the  battle  of  life  is  to 
cultivate  equanimity  and  follow  the  beautiful  precepts  of  Hindu 
philosophy,  which  teach  us  never  to  hunger  after  honors  and 
riches,  but  to  be  content  with  what  comes  in  our  way.  It  should 
be  a  lesson  to  us  as  to  what  to  avoid  when  we  take  note  of  the 
manner  in  which  so  many  American  business  men  sacrifice  their 
mind  and  health  in  an  insatiable  thirst  for  success  and  riches,  and 
after  attaining  them,  by  a  real  battle  with  life,  find  their  health 
so  impaired  that  they  reap  no  enjoyment  from  it.  What  is  the 
use  of  a  million  when  all  that  life  holds  dear  is  lost  in  the  struggle 
to  obtain  it,  and  when,  probably,  our  children  will  squander  it, 
as  do  many  sons  of  millionaires  who  have  worked  themselves  to 
death.     Rather  be  a  living  beggar  than  a  dead  millionaire ! 

In  the  succeeding  chapters  we  will  enter  fully  into  detail 
on  all  the  subjects  we  have  touched  upon  in  these  general  remarks. 
We  will  describe  the  functions  by  which  the  body  rids  itself  of 
toxic  products,  and  the  means  by  which  these  functions  may  be 
improved.  At  the  same  time  we  shall  set  forth  the  rational 
hygiene  of  the  organs  that  cause  the  elimination  of  poisons  either 
taken  through  food  or  introduced  from  without ;  and  after  having 
demonstrated  the  most  effective  mode  of  freeing  the  body  from 
such  poisons,  we  shall  mention  the  best  kinds  of  food  and  deal 
more  specifically  with  the  advantages  and  disadvantages  of  the 
various  kinds  of  food.  The  effects  of  certain  agencies  of  great 
benefit  to  the  health,  such  as  the  open  air,  sunshine,  exercise,  etc., 
will  be  treated  in  an  exhaustive  way.  Finally,  we  shall  show 
that  we  are  able  to  prevent  premature  old  age  in  an  effective 
manner,  and  even  to  treat  successfully  by  means  of  certain  drugs 
and  organic  extracts  the  condition  of  old  age  itself. 


CHAPTER  X. 

The  Destruction  and  Elimination  of  Toxic  Products 

from  the  Body  and  Hygienic  Measures  for 

the  Improvement  of  these  Functions. 

There  is  not  one  thousandth  of  an  inch  of  our  body  sur- 
face which  does  not  swarm  with  innumerable  bacteria,  and  as 
soon  as  the  continuity  of  our  skin  is  severed,  as  by  a  small 
wound,  they  immediately  invade  our  tissues  and  attack  us. 
Happily  we  are  not  without  means  of  defense.  Our  organism 
is  so  well  arranged  that,  as  soon  as  a  foreign  body  enters  which 
might  become  injurious,  a  kind  of  police  organization  comes  into 
action,  and  the  leucocytes,  like  policemen,  arrest  the  bacilli,  and 
render  them  harmless  by  eating  them  up.  This  is  phagocytosis, 
first  described  by  the  great  French  investigator,  Metschnikoff. 
And  so  marvelously  arranged  is  our  body,  that  there  are  also 
special  substances,  the  alexins  (Buchner),  which  aid  the  leu- 
cocytes, and  the  opsonins,  which  first  act  upon  the  bacteria,  so  as  to 
make  them  more  digestible  for  the  leucocytes. 

To  make  the  bacilli  still  more  sensitive  to  the  influence 
of  the  alexins  there  are  the  agglutinins,  observed  by  Bordet,  and 
by  Gruber  and  Durham,  which  immobilize  the  microbes,  and 
thus  aid  the  phagocytes  and  alexins  in  the  performance  of  their 
task. 

The  leucocytes  are  formed  in  the  lymphatic  tissues,  especially 
the  lymph  glands  and  spleen.  Thence  they  circulate  through  the 
body  and  offer  opposition  to  the  microbes  and'  other  foreign 
bodies  which  they  meet  on  their  way.  The  red  blood-corpuscles 
of  the  adult  are  formed  chiefly  in  the  bone  marrow. 

The  lymphatic  glands  play  an  important  role,  not  only  as  the 
birthplace  of  leucocytes,  but  also  in  that  they  are  able  to  arrest 
(134) 


Elimination  of  Toxic  Products  from  the  Body.  135 

noxious  substances,  such  as  microbes,  and  keep  them  from  enter- 
ing the  circulation.  That  the  lymphatic  structures  are  able  to 
protect  us  against  bacillary  infection  can  be  shown  by  the  swelling 
of  the  spleen  in  infectious  diseases, — such  as  typhoid  fever, 
malaria,  etc. 

The  tonsils  are  also  of  some  importance  for  our  protection 
against  harmful  substances.  They  become  inflamed  in  various 
infectious  diseases — such  as  scarlet  fever,  measles,  acute  nephritis, 
etc.  Their  great  value  may  best  be  shown  by  the  fact  that 
not  infrequently,  after  total  extirpation  of  both  tonsils,  a  gener- 
alized eruption  has  been  observed.  Thus  we  must  always  seri- 
ously reflect  before  advising  the  extirpation  of  these  important 
organs,  the  role  of  which  as  sentinels  is  shown  by  their  anatomical 
position  on  either  side  of  the  entrance  for  the  most  indispen- 
sable elements  of  our  life:  air  and  food.  Unless  frequent  in- 
flammation, and  possibly  irritative  nephritis,  demand  an  opera- 
tion, it  would  be  better  not  to  undertake  it.  Even  if  it  is 
done,  the  glands  should  never  be  entirely  removed. 

A  great  number  of  microbes  enter  our  system  through  the 
mouth  with  the  air  and  food,  but  happily  they  are  antagonized 
by  the  saliva  and  the  gastric  juice,  which  are  able  to  destroy  a 
large  number  of  these  obnoxious  invaders.  Like  the  ductless 
glands,  the  lymphatic  glands  are  closely  connected  with  one  an- 
other, and  thus  changes  in  one  of  these  glands  are  apt  to  be  fol- 
lowed by  changes  in  the  others.  Hence  we  can  see  how  a  lym- 
phatic structure  contained  in  the  intestine, — the  appendix, — 
can  often  become  inflamed  after  previous  inflammation  of  the 
tonsils.  As  is  well  known,  the  appendix  shows  great  similarity  in 
its  histological  structure  to  the  tonsils,  so  much  so  that  some  call 
it  an  intestinal  tonsil.  Several  authors  have  drawn  attention  to 
the  fact  that  appendicitis  has  often  been  observed  after  tonsilli- 
tis, and  Delcour  has  written  a  monograph  in  which  he  attrib- 
utes appendicitis,  indirectly,  to  thyroid  degeneration, — e.g.,  con- 
genital myxcedema.  Adenoid  vegetations  are  always  accom- 
panied by  chronic  pharyngitis  and  tonsillitis,  which  bring  about 


136  Old  Age  Deferred. 


appendicitis.  And  since  adenoid  vegetations  are  an  expression 
of  thyroid  deficiency,  Delcour  attributes  appendicitis  to  a  defi- 
cient thyroid.  We  are  not  prepared  to  accept  Delcour' s  state- 
ment, as  there  are  cases  of  adenoid  vegetations  without  a  deficient 
thyroid.  However,  as  we  have  personally  observed,  chronic 
nasal  catarrh  and  tonsillitis  are  very  frequent  in  persons  subject 
to  appendicitis.  The  appendix  is  an  important  lymphoid  organ 
and,  if  possible,  it  should  be  preserved. 

As  I  have  already  shown  in  a  previous  communication,1 
the  lymphatic  glands  stand  in  very  close  relation  to  the  thyroid 
gland.  In  diseased  conditions  of  the  thyroid  we  find,  as  a  rule, 
enlarged  lymphatic  glands,  as  in  Graves's  disease,  myxcedema, 
cretinism,  acromegaly,  and  also  in  diabetes.  The  thyroid  seems 
to  exert  a  great  influence,  not  only  upon  the  lymphatic  glands, 
but  also  on  the  blood-corpuscles.  The  red  blood-corpuscles  are 
diminished  after  extirpation  of  the  thyroid,  as  also  in  myx- 
cedema, as  well  as  in  old  age.  On  the  other  hand,  they  can  be 
increased  very  considerably  by  thyroid  feeding.  The  white 
blood-corpuscles  are  also  influenced  by  the  thyroid,  for,  after 
extirpation  of  the  thyroid,  their  number  is  at  first  increased  and 
later  diminished.  Very  important  is  the  discovery  of  Mile. 
Fassin2  (in  the  laboratory  of  the  University  of  Liege,  Belgium), 
who  found  a  diminution  in  the  production  of  alexins  after  ex- 
tirpation of  the  thyroid,  thus  confirming  what  Sajous  had  pointed 
out  four  years  earlier.  According  to  Sir  Almroth  Wright,  the 
discoverer  of  opsonins,  the  production  of  these  bodies  also  de- 
pends upon  the  internal  secretions.  We  have  seen  that  Sajous 
has  shown  (a  fact  confirmed  by  others  since)  that  opsonins  are 
mainly  composed  of  thyroid  secretion. 

Thus  we  see  that  the  production  of  antitoxins  is  greatly 
under  the  influence  of  the  thyroid,  which  governs  the  processes 
of  phagocytosis,  and  thus  powerfully  helps  in  the  defense  of 
our  system. 


1  Polielinique  de  Bruxelles,  Avril,  1903. 

2  Report  in  Centralblatt  iiir  Stoffwechsel,  1907. 


Elimination  of  Toxic  Products  from  the  Body.         137 

Besides  microbes,  we  introduce  into  our  body  a  large  num- 
ber of  harmful  products  through  food  and  drink  (stimulants). 
Many  toxic  substances  are  formed  by  the  decomposition  of  food, 
and  also  in  the  processes  of  metabolism  in  the  tissues.  We  are 
protected  against  these  substances  by  certain  organs  which 
destroy  them  (as  the  thyroid,  parathyroids,  and  liver),  and  by 
other  organs  which  eliminate  them  (as  the  kidneys,  the  skin, 
and  the  intestines).  When  these  organs  are  all  working  well, 
we  may  get  rid  of  these  products  and  not  be  affected  by  them; 
but  in  old  individuals  it  is  different,  as  their  protective  and 
eliminative  organs  have  more  or  less  degenerated.  Then  these 
substances  are  not  destroyed  entirely,  nor  wholly  eliminated. 
They  are  retained,  and  cause  the  condition  of  auto-intoxication. 

It  is  very  difficult  to  prove  definitely  by  experiments,  that 
there  really  exists  such  a  condition  as  auto-intoxication;  but, 
practically,  its  existence  cannot  be  denied.  We  note  after  changes 
in  the  above-named  organs,  when  their  functions  are  in  abey- 
ance, signs  of  intoxication  in  a  patient,  which  include  headaches 
and  other  nervous  symptoms,  with  a  haggard  and  colorless  face. 
After  a  good  movement  of  the  bowels,  perspiration,  and  abundant 
diuresis,  we  see  a  great  change  for  the  better.  Thus,  even  if 
scientific  experiments  which  are  made  on  small  animals  do  not 
strictly  confirm  the  existence  of  auto-intoxication,  the  great  im- 
provement in  our  condition  after  improved  elimination  speaks 
very  strongly  for  its  existence.  Therefore,  to  prevent  such  a 
condition,  we  must  do  our  best  to  keep  these  organs  in  good 
working  order.  In  the  succeeding  chapters  we  shall  consider  in 
detail  the  protective  and  eliminative  functions  of  these  organs, 
and  the  possibilities  of  their  improvement  by  hygienic  and  thera- 
peutic measures. 


CHAPTER  XI. 

On  the  Destruction  of  Poisonous  Products  Through  the 
Thyroid  and  Parathyroid  Glands. 

The  earliest  authorities  on  the  thyroid  gland,  including 
Schiff  and  others,  have  shown  that  when  this  gland  is  extir- 
pated in  a  dog,  as  a  rule  the  animal  develops  convulsions  after 
a  few  days,  and  subsequently  dies.  It  is  very  unusual  to  find  a 
longer  survival  after  such  operations. 

Interesting  and  very  instructive  experiments  by  the  Amer- 
ican specialist,  Dr.  Leo  Breisacher,  of  Detroit,  Mich,  (formerly 
assistant  to  Professor  Munk,  of  Berlin),  have  demonstrated  that 
it  is  possible  to  keep  animals,  operated  on  as  above,  alive  for 
a  long  time  if  they  are  debarred  from  meat  and  kept  on  a  milk 
diet. 

A  perfectly  natural  explanation  of  this  prolonged  survival, 
which  had  never  been  observed  until  the  above  experiments,  lies 
in  the  fact  that  milk  food  is  better  adapted  to  animals  deprived  of 
their  thyroid,  and  that,  as  Dr.  Breisacher  maintained,  meat  acts  in 
a  poisonous  manner  on  the  nervous  system  of  dogs  thus  operated 
on.  Thus  we  note  that  dogs  in  this  condition  cannot  live  on  a 
meat  diet.  The  learned  savant  and  others  noticed  that  dogs  so 
fed  succumbed  very  quickly,  while  at  the  same  time  he  observed 
that  no  attack  of  convulsions  ever  occurred  in  dogs  fed  on  milk, 
though  many  other  authorities  had  noticed  such  symptoms  in 
corresponding  cases. 

He  also  observed, — and  it  is  a  most  interesting  point, — that 
dogs  which  improved  on  a  milk  diet,  again  got  worse  after  meat 
or  bouillon  was  taken  and  died  in  consequence.  Of  great  im- 
portance also  is  his  observation  that  boiled  meat  is  not  dangerous 
to  animals  thus  operated  upon,  which  he  explains  as  being  due 
(138) 


Destruction  of  Toxic  Products  by  the  Thyroid.  139 

to  the  fact  that  the  extracts  of  meat  having  a  toxic  action  are 
soluble  in  water. 

There  can  thus  be  no  doubt,  from  these  beautiful  experi- 
ments of  Breisacher,  that  meat  does  contain  substances  that  are 
poisonous,  and  we  may  safely  draw  the  conclusion  therefrom  that 
if  we,  who  are  in  possession  of  our  thyroid,  do  not  suffer  from 
a  meat  diet,  it  is  due  to  the  protection  afforded  us  by  this  gland. 
If  we  remove  this,  as  in  the  instances  given  of  the  dogs,  or  if  it 
is  degenerated  by  disease,  then  our  immunity  also  disappears. 
In  myxcedematous  people  this  is  self-evident,  for  they  are  always 
worse  after  taking  meat,  and  most  of  them  have  an  antipathy  to 
this  sort  of  food.  Also  in  many  cases  of  severe  diabetes  (a  myx- 
oedematous  condition),  meat  is  very  injurious,  and  if  taken  in 
large  quantities  can  contribute  to  the  development  of  acidosis.1 

The  above-mentioned  experiments  of  Breisacher  have  been 
confirmed  by  F.  Blum,  of  Frankfort.  He  finds  also  that  omnivo- 
rous animals  operated  on  as  the  dogs,  if  fed  with  meat,  die  from 
tetany  in  a  few  days.  But  when  such  animals  have  been  kept 
on  milk  for  a  long  time,  before  and  after  the  operation,  a  large 
proportion  have  survived,  or,  at  most,  passed  through  a  mild 
form  of  tetany,  and  continued  well  until  meat  was  again  admin- 
istered, when  their  condition  soon  became  worse,  and  death 
ensued,  as  in  the  case  of  the  animals  kept  on  a  meat  diet.  Some 
of  the  dogs  fed  on  milk  also  died,  but  before  succumbing  they 
underwent  a  long  cachectic  illness.  In  any  event  they  lived 
longer  than  the  animals  fed  with  meat,  which  rapidly  died  with 
violent  symptoms. 

Dr.  Blum  arrived  at  the  conclusion  that  the  thyroid  is  a 
dis-intoxicating  organ  (entgiftendes  organ)  the  function  of 
which  is  to  destroy  poisonous  products  formed  by  the  decom- 
position of  the  albuminous  food-substances.2 


1  "Untersuchungen  liber  die  Glandula  Thyroidea,"  Breisacher:  Archiv 
fiir  Anatomie  und  Physiologie,  p.  504,  1890. 

2Virchow's  Archiv  fiir  Path.  Anatomie  und  Physiologie  und  klin.  Medi- 
cin,  vols.  158,  162. 


140  Old  Age  Deferred. 


The  Japanese  authority,  Kishi,  also  arrived  at  the  same 
conclusion,  after  having  removed  the  thyroid  gland  from  150 
monkeys,  dogs,  and  other  animals. 

That  the  products  of  the  decomposition  of  albuminoids  can 
produce  changes  in  the  thyroid  has  been  proved  by  Galeotti 
and  Lindemann,  who  found  an  increase  of  colloid  substance  in 
the  thyroid  of  animals  after  the  injection  of  leucin  and  tyrosin, — 
which  are  the  products  of  decomposition  of  albuminous  sub- 
stances. That  meat  acts  in  an  injurious  manner  on  the  thyroid 
gland,  if  eaten  in  very  large  quantities,  has  been  proved  by  clinical 
observations  and  by  the  experiments  of  Chalmers  Watson,  into 
which  we  shall  enter  more  fully  in  the  chapter  on  the  dangers  of 
too  free  a  meat  diet. 

The  thyroid  not  only  protects  us  against  the  poisons  in  meat, 
but  also  against  many  others ;  in  fact,  perhaps  we  may  say, 
against  poisons  generally.  Let  us,  however,  specially  mention 
those  poisonous  products  which  have  been  tried  experimentally. 
That  the  thyroid  protects  the  body  against  bacillary  attacks  has 
been  noted  by  Charrin  in  the  case  of  dogs,  which  succumb  in  a 
very  short  time  to  all  kinds  of  infection  after  the  removal  of  the 
thyroid.  We  have  demonstrated,  in  Chapter  III,  the  protec- 
tive action  of  the  gland  against  such  poisons  as  chloroform,  as 
mentioned  in  our  communication  to  the  Paris  Biological  Society 
in  1906,  where  we  stated  that  in  chloroform  narcosis  all  the 
characteristics  of  an  increased  activity  of  the  thyroid  are  per- 
ceived,— including  symptoms  such  as  we  see  in  Graves's  disease. 
We  have  also  found  that  the  thyroid  of  dogs  contains  an  in- 
creased amount  of  colloid  substance  after  chloroform  narcosis, 
which  enables  us  to  understand  why  this  drug  is  not  well  borne 
by  animals  operated  upon  as  above,  as  discovered  by  Lanz  and  by 
Walter  Edmunds ;  likewise,  we  may  thereby  explain  why  patients 
suffering  from  Graves's  disease  of  long  standing,  in  which  there 
generally  is  a  transition  to  a  myxedematous  condition,  are  liable 
to  a  fatal  termination  after  an  operation  with  anesthesia.  Cases 
of  diabetes  (in  accord  with  frequency  of  thyroid  changes)  also 


Destruction  of  Toxic  Products  by  the  Thyroid.  Ill 

often  present  serious  phenomena  after  an  operation  under  anes- 
thesia, including  coma  and  even  death. 

Alcohol  also  acts  on  the  thyroid  gland,  there  being  a  cer- 
tain analogy  between  intoxication  by  chloroform  and  by  alcohol. 
The  changes  in  the  thyroid  after  the  long-continued  use  of  alcohol 
are  the  consequences  of  the  frequent  conditions  of  hyperactivity 
of  this  gland,  expressive  of  its  antitoxic  action.  We  have  re- 
ferred to  the  influence  of  alcohol  on  the  thyroid  in  other  parts 
of  this  book.  This  gland  also  protects  us  against  injurious  drugs. 
Hunt,  of  Washington,  has  shown  from  experiments  that  when 
certain  animals,  such  as  rabbits,  have  been  given  acetonitril  and 
thyroid  preparations  at  the  same  time,  they  do  not  become 
poisoned ;  whereas  when  they  have  taken  the  former  alone,  they 
do.  Jeandelize  and  Perrin  have  also  proved  the  protective  action 
of  the  thyroid  against  arsenic. 

Gamier  has  also  found  that  certain  drugs,  such  as  iodine, 
pilocarpin,  etc.,  when  injected  into  animals,  produce  an  increase 
of  colloid  secretion  in  the  thyroid  glands.  It  is,  therefore,  but 
logical  to  regard  this  hyperactivity  of  the  thyroid  gland  as  an 
expression  of  its  defensive  action  against  toxic  products  (see 
Chapter  III). 

From  the  foregoing  it  is  obvious  what  an  important  organ 
we  possess  in  the  thyroid  gland,  and  that  by  its  degeneration, 
as  in  the  state  of  myxcedema  or  in  the  much  more  frequent  athy- 
roidia,  we  become  more  exposed  to  all  kinds  of  poisonous  prod- 
ucts; but  what  renders  its  degeneration  a  still  graver  misfortune 
for  us,  is  the  fact  that  it  is  apt  to  bring  about  the  degeneration 
also  of  other  organs  which  destroy  and  eliminate  poisonous 
products,  viz. :  the  liver,  kidneys,  intestines,  and  skin. 

The  liver  is  always  altered  by  extirpation  of  the  thyroid 
gland,  likewise  as  a  rule  in  myxcedema,  and  even  in  hypothy- 
roidia;  for  congestion  and  other  changes  follow,  as  found  by 
Rogowitch,  Sanquirico,  and  Canales,  Albertoni,  Tizzoni,  and 
others.  A  fatty  degeneration  of  the  liver  has  also  been  described 
by  Sciolla. 


142  Old  Age  Deferred. 


Laulanie  has  discovered,  in  the  same  way  as  Van  der  Ecke 
and  Rosenblath,  very  extensive  changes  in  the  liver  after  re- 
moval of  the  thyroid.  Jeandelize  also  found  interstitial  hepatitis 
after  the  removal  of  the  thyroid  and  parathyroids.  Kishi  also 
describes  alterations  in  the  blood-vessels  of  the  liver  occurring 
in  a  great  number  of  animals  after  thyroidectomy. 

Hun,  Prudden,  Mackenzie,  G.  Murray,  and  others,  found 
usually  a  cirrhosis  of  the  liver  in  myxcedematous  persons. 
Vermehren  found  an  interstitial  hepatitis,  with  thickening  of  the 
blood-vessels  of  the  liver,  and  of  the  bile,  in  myxcedema. 

It  is  also  of  great  significance  to  note  that  Gley,  Laulanie, 
and  others,  constantly  found  biliary  matters  present  in  the  urine 
of  animals  from  which  the  thyroid  had  been  removed. 

After  due  consideration  of  these  facts  it  cannot  be  denied 
that  the  liver  and  the  thyroid  stand  in  very  close  relationship, 
and  this  we  maintained  at  the  last  French  Congress  of  Medicine 
at  Liege,  where  we  were  glad  to  see  that  the  President  of  the 
Congress,  Professor  Bouchard  of  Paris,  and  later  Professor 
Neusser  of  Vienna,  coincided  in  this  opinion. 

We  have  also  shown,  as  already  mentioned  (Chapter  V), 
that  degenerative  processes  of  the  thyroid  are  able  to  facilitate 
the  development  of  the  gall-stone  complaint.  The  degeneration 
of  the  thyroid  is  not  only  followed  by  degeneration  of  the 
liver,  but  also  by  that  of  the  kidneys. 

It  has  been  noted  by  Albertoni  and  Tizzoni,  that  animals 
whose  thyroid  has  been  removed  show  a  condition  of  interstitial 
nephritis.  Blum  has  found  the  same  thing,  and  has  observed  also 
that  this  condition  frequently  comes  about  in  an  astonishingly 
short  time  after  the  operation,  say,  in  18  to  20  days.  The  paren- 
chyma also  presents  distinct  signs  of  inflammation;  the  urinary 
channels  lose  their  epithelium  and  present  the  appearance  of 
hollow  grooves.  These  changes  occur  in  all  animals,  except 
such  as  die  a  few  days  after  the  operation,  and  such  as  are 
permanently  immune  from  the  intoxication  that  follows  the 
removal  of  the  thyroid. 


Destruction  of  Toxic  Products  by  the  Thyroid.  143 

We  can  also  observe  clinically  that  removal  or  degeneration 
of  the  thyroid  are  capable  of  producing  changes  in  the  kidneys; 
for  after  the  operation,  as  a  rule,  albumin  appears  in  the  urine. 

In  myxcedema  and  hypothyroidia  there  is  also  very  fre- 
quently albumin  in  the  urine,  as  well  as  hyalin  or  granular  casts. 
In  such  cases  the  urine  is  usually  not  copious ;  very  frequently 
it  is  scanty  (oliguria),  and  its  light  color  and  low  specific  gravity 
show  that  the  solids  have  been  retained  in  the  body.  In  such 
cases  there  is  often  retention  of  uric  acid.  In  a  communication 
to  the  Paris  Biological  Society  (February  25,  1905)  we  attrib- 
uted gout  to  changes  in  the  kidneys  giving  retention  of  uric  acid, 
after  primary  alterations  of  the  thyroid  as  the  cause  (see  also 
Chapter  V). 

That  the  intestines  also  suffer  changes  after  degeneration 
of  the  thyroid  is  best  established  by  the  fact  that  there  is  obsti- 
nate constipation  in  such  cases, — as  in  myxoedema  or  in  partial 
myxoedema  and  hypothyroidia  (old  age).  The  functions  of  the 
skin  also  will  be  diminished  after  degeneration  of  the  thyroid, 
as  we  observe  plainly  in  the  conditions  of  myxcedema  and  hypo- 
thyroidia. In  these  diseased  conditions  there  is  an  atrophy  of 
the  sudorific  and  sebaceous  glands,  so  that  the  skin  cannot  per- 
spire ;  on  this  account  a  large  amount  of  toxic  products  is 
retained. 

We  can  see  plainly  from  the  above  that  when  a  person  has 
a  degenerated  thyroid  a  condition  of  auto-intoxication  must 
necessarily  follow,  as  there  is  in  consequence  a  degeneration  also 
of  the  other  organs  which  destroy  and  eliminate  poisonous  ma- 
terials. The  liver  in  such  a  case  will  not  be  able  to  fulfill  its 
function  of  destroying  a  mass  of  poisonous  substances ;  the  slug- 
gish kidneys  and  bowels  will  not  eliminate  them  sufficiently,  and 
dry  skin  will  also  contribute  to  their  retention,  since  its  insensible 
respiration  is  not  taking  place.  All  these  life-shortening  agencies, 
which  may  combine  to  cause  premature  old  age,  can  be  brought 
back  to  a  primary  cause — the  degeneration  of  the  thyroid  gland. 

When  the  thyroid  is  removed  from  an  animal,  but  the  para- 


144  Old  Age  Deferred. 


thyroids  are  allowed  to  remain,  that  animal  will  not  then  suffer 
convulsions,  but  will  only  present  the  symptoms  of  cachexia 
typical  of  the  operative  cases  of  myxcedema. 

It  has  been  shown  by  Gley,  Vassale,  and  Generali,  that  these 
very  small  glandular  organs,  of  which  there  are  four,  two  internal 
and  two  external  ones,  possess  quite  a  different  structure  from 
the  thyroid  gland. 

It  has  been  demonstrated  by  many  authorities,  among  them 
Jeandelize,  that  the  convulsions  which  follow  the  removal  of  the 
thyroi'd  are  due  to  the  fact  that  the  parathyroids  have  been  re- 
moved completely,  together  with  the  thyroid  gland.  Jeandelize 
was  able  to  produce  convulsions  by  merely  removing  the  para- 
thyroids alone;  he  attributed  tetany  and  epilepsy  to  the  changes 
in  the  parathyroids,  in  common  with  other  authorities,  who  have 
even  obtained  good  results  in  epilepsy  with  parathyroid  treatment. 

Several  authorities  besides  Jeandelize  have  attributed  tetany 
to  alterations  of  the  parathyroids :  for  instance,  Pineles ;  and 
at  the  German  Congress  of  Medicine  in  Munich,  Erdheim  com- 
municated his  observations  in  three  cases  of  tetany,  in  each  of 
which,  at  the  post-mortem,  there  was  found  hypertrophy  of  the 
parathyroids. 

Dr.  Macallum,  of  Johns  Hopkins  University,  has  also  re- 
ported the  case  of  a  person  who  developed  tetany  in  consequence 
of  a  dilatation  of  the  stomach,  and  in  whom  the  parathyroids 
were  found  to  be  hypertrophied. 

We  learn  from  the  foregoing  that  the  parathyroids  protect 
us  against  poisons  that  arise  from  the  stagnation  of  the  contents 
of  the  stomach,  and  that  their  integrity  is  necessary  as  a  safe- 
guard against  important  alterations  of  the  nervous  system. 

However,  these  glands,  which  were  already  described  by 
Sandstrom  twenty-two  years  ago,  have  not  been  studied  as  yet  to 
the  same  extent  as  the  thyroid,  and  we  cannot  enlarge  further 
on  this  subject  at  the  present  time. 


CHAPTER  XII. 
Hygiene  of  the  Thyroid  Gland. 

The  rational  hygiene  of  the  thyroid  gland  consists  in  the 
avoidance  of  all  agencies  that  may  prove  harmful  to  the  gland, 
the  most  important  of  which  are  infectious  diseases;  frequent 
pregnancies;  sexual  excesses;  intoxications  by  food,  stimulants, 
or  drugs ;  and  emotions  such  as  grief,  sorrow,  etc. 

It  will  not  be  difficult  to  prevent  some  of  these,  but  it  will 
be  nearly  impossible  to  avoid  others,  such,  for  instance,  as  infec- 
tious diseases.  There  is  not  the  least  doubt,  however,  that  at 
times  we  expose  ourselves  quite  unnecessarily  to  infections,  as 
when  we  drink  water  that  has  not  been  boiled  or  filtered,  or  when 
we  take  milk  from  uninspected  dairies  for  a  long  time ;  or,  again, 
when  we  remain  too  long  a  time  in  the  confined  air  of  assembly 
halls,  etc.,  and  breathe  the  air  that  has  been  exhaled  by  thousands 
of  others,  many  of  them  possibly  with  infectious  diseases  of  the 
throat  and  lungs.  Many  a  case  of  infectious  disease,  with  all  its 
dangers  to  life  or  to  important  organs,  such  as  the  thyroid,  may 
be  avoided  by  proper  circumspection. 

It  is  also  quite  unnecessary  for  us  to  expose  ourselves  to  the 
dangers  arising  from  the  decomposition  of  meat,  which  is  par- 
ticularly injurious,  when  taken  in  large  quantities,  to  the  thyroid, 
as  shown  by  the  experiments  of  Breisacher,  Blum,  Chalmers 
Watson,  etc.,  more  especially  if  animal  food  be  taken  that  is 
not  quite  fresh  and  can  cause  the  formation  of  ptomaines.  Ac- 
cording to  Blum  the  thyroid  has  the  special  function  of  destroy- 
ing poisons  formed  in  the  intestines,  in  particular  by  the  decom- 
position of  animal  food.  Now  when  too  much  work  is  thrown 
up  on  this  important  gland,  it  is  easy  to  understand  that  after  a 
time  it  will  give  out,  and  to  prevent  this  we  must  avoid  taking 

10  (145) 


146  Old  Age  Deferred. 


large  quantities  of  animal  food  or  fish  (which  is  meat  also,  a  fact 
not  realized  by  many  people),  and  when  we  do  take  it,  we  must 
first  be  certain  that  it  is  in  a  fresh  condition.  To  enable  us  to  do 
this  we  are  provided  with  special  sense-organs,  and  our  eyes, 
nose,  and  the  taste  papillae  of  our  tongue  will  inform  us  whether 
the  meat,  and  especially  the  fish  or  crustacean,  is  in  a  fit  condition 
to  be  eaten. 

We  have  mentioned  several  times  that  alcohol  and  tobacco, 
taken  in  large  quantities  or  for  a  long  time,  are  deleterious  to 
the  thyroid,  which  fact  will  justify  our  abstinence  therefrom,  or 
the  greatest  moderation  in  their  employment ;  those  who  can  do 
without  stimulants  will  always  be  the  best  off. 

Sexual  excesses  can  also  be  easily  avoided,  and  women  who 
wish  to  retain  their  youth  will  do  well  not  to  expose  themselves 
to  pregnancies  year  after  year  after  having  had  three  or  four  chil- 
dren. It  is,  however,  great  good  fortune  to  have  a  numerous 
progeny,  and  by  careful  hygiene,  as  plenty  of  instances  prove,  the 
struggle  against  premature  old  age  can  be  carried  out  success- 
fully. In  regard  to  this  we  may  refer  to  the  chapters  on  the 
causes  of  old  age  and  on  sexual  hygiene.  Diseases  of  the 
ovaries  must  be  particularly  avoided,  as  all  changes  in  those 
glands  will  react  on  the  thyroid,  which  is  closely  related  to  them. 

Doubtless  one  of  the  most  difficult  tasks  will  be  the  avoid- 
ance of  strong  emotions :  grief  and  sorrow ;  .and  yet  we  are 
not  helpless  against  them,  as  will  be  illustrated  in  the  chapter  on 
the  hygiene  of  the  mind  and  on  the  advantages  of  a  religious 
belief. 

Having  dwelt  on  the  necessity  of  preventing  injury  to  this 
important  gland,  we  will  now  show  that  there  are  certain  means 
of  enhancing  its  vitality, — which  effect  we  can  obtain  by  improv- 
ing the  circulation,  and  removing  agencies  by  which  this  would 
be  impaired.  As  Sir  Herman  Weber  has  shown,  it  is  possible  to 
improve  the  working  condition  of  this  gland  by  massage,  which 
should  be  done  daily  and  is  readily  carried  out. 

It  is  easy  to  see  that  a  tight  collar  offers  difficulty  to  the 


Hygiene  of  the  Thyroid  Clauds.  1  I  i 

free  circulation  of  the  blood  through  this  gland,  and  therefore 
it  is  advisable  to  wear  a  loose,  and  also  low,  one.  Strange  to  say, 
many  ladies  wear  such  tight,  high  collars,  not  availing  themselves 
of  their  immunity  from  such  a  yoke,  which  men  have  voluntarily 
endured  for  so  long  a  time.  It  is  advantageous  not  to  button 
both  sides  of  the  shirt-band  to  which  the  collar-stud  is  fastened, 
but  one  side  only,  which  is  easily  done  when  low  collars  are  worn 
and  is  not  noticeable;  the  great  comfort  and  advantage  of  so 
doing  will  outweigh  all  other  considerations. 

The  vitality  of  the  thyroid  gland  may  be  enhanced  by  vari- 
ous measures  in  which  thyroid  secretion,  or  iodine — its  main  ele- 
ment,— is  introduced  into  the  body.  The  easiest  way  to  effect 
this  is  by  taking  foods,  such  as  plants  and  vegetables,  which  con- 
tain a  maximum  of  iodine.  The  iodine  in  the  thyroid  and  other 
parts  of  the  body  is  introduced  therein  mainly  with  our  food  (or 
by  drugs  in  the  case  of  goiter).  Another  way  is  by  taking  thy- 
roid extracts.  Since,  at  a  certain  age, — as  mentioned  in  the 
chapter  on  the  causes  of  old  age, — parts  of  the  epithelium  of  the 
thyroid  are  degenerated  and  replaced  by  connective  tissue,  thyroid 
extracts  will  be  the  best  means,  if  taken  in  very  small  doses,  of 
supplying  this  physiological  need.  Such  doses  of  the  extracts, 
freshly  prepared  and  from  a  reliable  firm,  can  do  no  harm,  but, 
on  the  contrary,  will  keep  the  thyroid  in  good  working  order. 
As  we  have  learned  from  personal  experience  these  very  small 
doses  can  even  be  taken,  at  intervals,  for  a  long  time,  without 
injury  to  the  health,  and  we  need  not  await  the  arrival  of  old 
age,  but  should  use  them  as  a  preventative  against  it,  and  in 
particular  temporarily  where  there  is,  or  has  been,  a  great  demand 
for  thyroid  secretion,  as,  for  instance,  in  convalescence  after  an 
infectious  disease,  or  after  childbirth,  especially  if  the  flow  of 
milk  is  scanty,  which  is  an  expression  of  a  defective  thyroid ;  also 
after  sexual  excesses,  and  in  cases  of  mental  depression,  after 
we  have  suffered  grief ;  in  fact,  after  any  of  the  occurrences  which 
we  know  to  be  harmful  to  the  thyroid  gland,  which,  in  such  cases, 
has  been  giving  off  larger  amounts  of  its  secretion. 


148  Old  Age  Deferred. 


We  must,  however,  caution  patients  against  ever  taking 
these  extracts  save  under  medical  advice,  since  otherwise  dan- 
gerous results  may  be  and  have  been  produced,  as  will  be  shown 
elsewhere. 

The  diet  of  greatest  hygienic  value  with  regard  to  the 
thyroid  will  consist  of  large  quantities  of  milk,  with  little  or  no 
meat,  but  plenty  of  vegetables. 

With  such  a  diet  there  will  result  less  putrefaction  in  the 
intestines,  and  thus  also  less  demand  for  the  thyroid  secretion  to 
destroy  poisonous  matters ;  at  the  same  time,  along  with  the  milk 
and  vegetables,  iodine,  the  main  element  of  the  thyroid  secretion, 
will  be  brought  into  the  body,  and  a  loss  of  this  product  from  it 
prevented. 


CHAPTER     XIII. 

The  Destruction  of  Toxic  Products  by  the  Liver  and 
the  Improvement  of  its  Protective  Functions. 

The  liver  is  one  of  the  most  important  of  our  organs.  As 
Professor  Hemmeter,  of  Baltimore,  says,  "The  liver  is  an  organ 
secondary  in  importance  only  to  the  heart.  Living  things  can 
exist  without  stomachs.  They  can  live  for  forty  days  without 
eating,  but  mammalia  can  only  live  a  few  days,  sometimes  not 
twenty-four  hours,  without  a  liver."  The  importance  of  the 
functions  of  the  liver  is  illustrated  in  this  picturesque  remark  of 
Dr.  Rovighi1 :  "Like  unto  Minos  in  Dante,  the  liver  tests  the 
conscience  of  those  that  want  to  enter,  and  knows  their  sins." 

We  introduce  into  our  stomach  and  intestines  a  number  of 
poisonous  substances  which,  if  injected  into  our  blood,  would 
kill  us,  or  at  least,  cause  grave  intoxication.  Yet  because 
they  are  taken  by  the  mouth  they  are  harmless,  and  the  reason 
for  this  strange  phenomenon  is  that  they  must  pass  through  the 
liver,  being  brought  to  this  organ  from  the  intestines  through 
the  portal  vein,  and  are  there  destroyed.  This  is  illustrated  in 
the  case  of  the  Indian  snake  charmers,  who  acquire  immunity 
against  snake-bites  after  having  first  sucked  the  poisonous  fang 
of  the  snakes  and  absorbed  the  toxin  via  the  intestine.  They 
thereby  gradually  accustom  their  body  to  this  terrible  poison, 
which,  taken  in  this  manner,  is  far  less  harmful,  since  it  passes 
through  the  liver.  That  the  liver  destroys  various  poisons  was 
first  shown  by  our  esteemed  friend,  Prof.  Paul  Heger,2  of  Brus- 
sels University,  who  demonstrated  by  experiments  that  nicotin 

1  Quoted  after  Professor  Hemmeter.     Address  to  Sixty-first  Annual  Meet- 
ing of  the  Ohio  State  Medical  Association,  May  9-11,  Canton,  Ohio. 

2Th§se   de   Bruxelles,   1873;     Journal   mgd   de  Bruxelles,    1877;    C.   R. 
de  l'Acad§mie  des  Sciences,  May,   1880. 

(149) 


150  Old  Age  Deferred. 


added  to  blood  soon  disappeared  after  it  had  been  passed  through 
the  liver  artificially.  After  this  remarkable  discovery  other  au- 
thorities have  found  reason  to  state  that  the  liver  also  destroys 
other  poisons,  in  particular  alkaloids :  strychnine  and  atropine 
(Professor  Roger3),  hyoscyamine  (Heger  and  Buys4),  quinine, 
morphia,  curare  (Lussana).  According  to  Scruff,  and  Lauten- 
bach,  alkaloids  undergo  a  chemical  change  under  the  influence  of 
the  liver.  As  SlowzofF  found,  the  liver  also  protects  us  against 
poisons  such  as  arsenic ;  therefore  we  can  understand  why  persons 
suffering  from  hepatic  disease  cannot  tolerate  arsenic.  This 
should  be  taken  into  consideration  when  we  are  treating  patients 
with  cacodylates,  or  with  atoxyl. 

It  has,  however,  been  maintained  by  Zagari  that  this  anti- 
toxic action  of  the  liver  fails  in  the  case  of  bacteria  and,  according 
to  Professor  Roger,  especially  with  bacterial  toxins  in  old 
cultures. 

Yet  other  authors  have  shown  that  the  liver  probably  has 
an  antitoxic  action  against  bacteria  and  their  toxins.  Thus,  Pro- 
fessor Adami,  of  Montreal,6  by  experiments  with  a  minute 
diplococcus  similar  to  that  which  is  found  in  Pictou's  cattle 
disease,  and  Sir  Lauder  Brunton,  and  Dr.  Bokenham,7  have 
shown  that  the  lethal  action  of  diphtheria  toxin  is  greatly  dimin- 
ished during  the  circulation  of  this  toxin  through  the  liver,  and 
also  that  the  juice  from  such  a  liver  has  a  slight  antitoxic  power. 
These  authors  have  also  shown  that  the  bile  from  such  a  liver 
has  a  slight  antitoxic  action.  They  consider  that  the  antitoxic 
power  of  the  liver  does  not  depend  upon  the  blood  present  in  the 
organ,,  but  on  the  liver  tissue  itself. 

It  has  been  shown  that  the  liver  excretes  into  the  bile  poi- 
sons which  it  arrests  during  their  circulation  through  the  portal 


3  These  de  Paris,  1887. 

4  Quoted  from  Hanot,  Archives  Gen.  de  Medecine,  II,  -895. 

5  SlowzofF:     Beitr.  zur  chem.  Physiologie  u.  Path.,  p.  281,  1901. 
6 Adami:  Montreal  Med.  Journal,  p.  485,  July. 

7  Sir  Lauder  Brunton  and  Bokenham :      The   Journal   of  Pathology  and 
Bacteriology,  p.  50,  Nov.,  1907. 


Destruction  of  Toxic  Products  by  the  Liver.  151 


system.  This  has  been  shown  by  Lussana  in  the  case  of  curare. 
That  poisonous  substances  are  excreted  into  the  bile  is  shown 
also  by  the  immunizing  experiments  of  Professor  Koch  against 
bovine  plague.  He  employs  the  bile  of  animals  which  died  of 
plague.  This  contains  attenuated  plague  bacilli,  of  which  Pro- 
fessor Koch  makes  use  in  his  experiments.8 

Dr.  Fraser0  has  shown  that  when  increasing  doses  of  snake 
venom  are  injected  into  an  animal  a  condition  of  immunity  is 
brought  about,  so  that  finally  fifty  times  the  dose  which  would 
have  proved  fatal  at  first,  becomes  innocuous.  As  Fraser  found, 
the  bile  of  such  animals  contains  an  antivenine,  and  he  made 
use  of  this  bile  as  an  antidote  against  the  original  venom. 

These  experiments  prove  that  the  bile  contains  poisonous 
substances,  including  pathogenic  bacteria  in  an  attenuated  con- 
dition, and  also  that  it  has  antitoxic  properties.  Thus  we  may 
understand  how  it  can  neutralize  putrefactive  products  from  the 
intestines.  Not  only  bacteria,  but  all  the  various  kinds  of  poison 
which  the  liver  destroys,  are  eliminated  by  the  bile;  hence  the 
importance  of  a  free  circulation  of  this  fluid.  The  liver  serves 
as  a  depot  for  metallic  substances  like  iron  and  copper,  and  also 
for  the  more  dangerous  ones  such  as  lead,  mercury,  arsenic,  or 
antimony.  After  first  keeping  them  in  storage,  it  then  attempts 
to  eliminate  these  noxious  substances.  According  to  Slowzoff 
and  Bamossi,  the  various  poisonous  metals  and  alkaloids  enter 
into  combinations  with  the  proteid  bodies  of  the  liver.  Animals 
that  have  been  richly  fed  have  been  found  to  be  better  protected 
against  these  poisons  because  of  their  livers  being  richer  in 
proteid  contents  and  glycogen. 

The  liver  also  protects  the  body  against  the  numerous  toxic 
products  formed  in  the  stomach  and  intestines  during  the  process 
of  digestion  and  assimilation.  The  most  important  of  these  are 
the  carbamins  and  ammonia  salts,  which  would  be  injurious  to  us 
if  the  liver  did  not  protect  us  by  converting  them  into  urea. 


s  Quoted  after  Metschnikoff. 

9  Fraser:  British  Med.  Journal,  vol.  ii,  p.  595,  1897. 


152  Old  Age  Deferred. 


When  the  liver  is  excluded  from  the  circulation,  as  Nencky 
and  his  pupils  have  secured  by  establishing  an  Eck's  fistula,  then 
toxic  symptoms  arise  when  the  animals  are  given  albuminous 
food,  and  these  symptoms  can  only  be  explained  from  the  fact 
that  the  liver  is  unable  to  destroy  toxic  products.  The  more 
albuminous  food  taken,  the  more  marked  are  the  symptoms  of 
intoxication. 

The  liver  aids  in  the  transformation  of  the  poisonous  end- 
products  of  proteid  metabolism  by  bringing  about  the  combina- 
tion of  the  toxic  end-products  with  sulphuric  acid  (Baumann, 
Emden  and  Glaesner).  Thus  these  dangerous  substances  are 
eliminated  as  ethereal  sulphates,  which  are  practically  harmless. 
Even  when  these  ethereal  sulphates  are  present  in  large  amounts 
in  the  urine  there  may  be  no  symptoms  of  auto-intoxication. 

When  the  liver  is  extirpated,  a  condition  of  acidosis  arises, 
and  a  large  quantity  of  ammonia  is  eliminated,  which  is  produced 
in  order  to  neutralize  the  acids  present.  The  liver  protects  us 
against  acids  formed. in  the  organism.  After  eating  a  quantity  of 
meat,  we  would  be  menaced  by  the  acids  formed  through  its 
decomposition,  were  the  liver  not  active. 

We  can  prevent  acidosis  if  we  eat  a  considerable  amount 
of  carbohydrates,  at  least  ioo  grammes  a  day  as  Hirschfeld  has 
proved.  It  has  been  shown  by  Waldvogel  that  these  carbohy- 
drates do  not  prevent  acidosis  if  they  are  given  by  a  method  which 
precludes  their  passage  through  the  portal  circulation, — e.g., 
subcutaneously. 

As  we  have  seen  above,  the  liver  receives  an  enormous 
amount  of  toxic  products  from  the  stomach  and  intestine,  which 
it  transforms  or  destroys.  Like  any  other  organ  which  is  over- 
worked, the  liver  may  undergo  certain  changes  when  continually 
subjected  to  a  strain,  and  great  quantities  of  these  toxins  might 
be  able,  after  a  long-continued  action,  to  alter  the  liver  tissue. 
Such  a  condition  we  may  note  in  gastric  and  intestinal  diseases, 
especially  in  those  cases  where  large  amounts  of  fatty  acids  are 
formed. 


Destruction  of  Toxic  Products  by  the  Liver.  153 

Bouchard  found  an  enlargement  of  the  liver  in  23  per  cent. 
of  all  his  cases  of  dilatation  of  the  stomach. 

We  can  understand  that  when  fatty  acids,  as  a  result  of 
gastro-intestinal  disease,  pass  for  a  long  time  through  the  liver, 
they  may  destroy  the  delicate  epithelium  of  this  organ.  Boix 
demonstrated  this  by  experiments.  By  feeding  animals  with 
lactic,  butyric,  and  acetic  acids,  he  produced  hepatic  cirrhosis. 

So  long  as  the  liver  is  healthy  it  is  able  to  withstand  the  con- 
stant inflow  of  toxins  and  will  transform  them  into  less  harmful 
compounds.  But  when  the  liver  is  altered,  as  in  cirrhosis, 
things  are  different.  We  then  find  a  diminution  of  urea,  and 
an  increase  of  ammonia.  Happily  such  a  condition  arises  only 
when  there  are  considerable  anatomical  and  histological  changes 
in  the  liver. 

Salaskin  and  Zaleski  have  shown  in  animals  that  when 
there  are  serious  anatomical  changes  in  the  liver,  the  ammonia 
is  increased,  and  the  urea  is  diminished.  We  may  suppose  that 
in  old  age,  when  the  connective  tissue  is  more  or  less  increased 
and  important  liver  elements  destroyed,  a  similar  decrease  in  the 
urea  formation  may  take  place  just  as  in  chronic  cirrhosis. 

That  in  diseases  of  the  liver  toxic  products  are  formed 
and  eliminated  by  the  urine  in  increased  amounts,  has  been  shown 
by  Professors  Bouchard10  and  Roger.  They  found  that  the 
urine  of  patients  suffering  from  diseases  of  the  liver  is  more  toxic 
than  that  of  normal  persons. 

That  the  normal  urine  is  toxic  has  been  proved  by  Seglas 
and  Vauquelin,11  and  also  by  Bocci.12  Bouchard  has  designated 
as  the  urotoxic  unit  the  quantity  of  urine  necessary  to  kill  an 
animal  weighing  1  kilogramme,  and  as  the  urotoxic  co-efficient 
the  relation  of  the  urotoxin  eliminated  in  twenty-four  hours  to  the 
body  weight  of  the  animal.  This  latter,  then,  indicates  the  quan- 
tity of  urotoxins  a  man  eliminates  in  twenty-four  hours. 


10  Lemons  sur  les  autointoxications  dans  les  maladies. 

11  Journal  de  Magendie,  vol.  ii,  p.  357,  1822. 
i2Centralbl.  fur  med.  Wiss.  51,  1882. 


154  Old  Age  Deferred. 


All  these  calculations  of  Bouchard  have  had  no  great  suc- 
cess, however,  for  many  authorities,  as  Gumprecht,13  Heymans 
v.  d.  Bergh,  etc.,  have  shown  that  the  toxic  effects  of  the  injected 
urine  may  be  explained  in  part  by  the  difference  in  osmotic 
pressure  between  the  injected  urine  and  the  blood. 

Still  the  fact  remains  that  the  urine  of  many  cases  of  liver 
disease  has  been  found  to  be  more  toxic  than  the  urine  of  other 
persons. 

When  the  liver  is  damaged  it  cannot  destroy  poisons  in  the 
normal  manner,  as  was  shown  by  experiments.  Thus,  the  liver 
cells  have  been  experimentally  injured  when  it  was  found  that 
such  a  liver  was  not  able  to  destroy  strychnine  as  well  as  a  normal 
liver.  Very  important  findings  have  been  made  by  Roger  and 
Gamier.14  They  have  ascertained  that  privation,  bad  nutrition, 
etc.,  can  also  lower  the  vitality  of  the  liver  and  diminish  its  anti- 
toxic properties. 


13  Centralbl.  fur  Inner.  Med.,  24,  1897. 

14  Roger  et  Garnier:  C.  R.  Soc.  de  biol.,  p.  209,  1899. 


CHAPTER  XIV. 
The  Hygiene  of  the  Liver. 

We  have  often  observed  that  people  suffering  from  diseases 
of  the  liver  feel  and  look  much  better  after  abstaining  from  meat 
and  living  on  milk  and  a  vegetarian  diet.  If  such  a  diet  be  bene- 
ficial in  cases  where  the  tissues  of  the  liver  are  degenerated,  it 
appears  reasonable  to  assume  that  it  will  be  equally  efficacious 
when  the  liver  has  not  yet  been  altered  by  disease.  We  must 
realize  that  the  various  unwholesome  matters  we  eat  or  drink- 
are  carried  to  the  liver  to  be  dealt  with,  and  that  the  end-products 
of  the  decomposition  of  the  meat,  and  other  elements  contained  in 
preserved  meat  which  may  not  be  perfectly  sound,  may  injure 
the  liver-tissue,  or,  at  any  rate,  throw  more  work  on  this  organ 
than  food  in  the  nature  of  vegetables  or  milk. 

A  milk  diet  has  the  further  great  advantages  that  it  assists 
in  destroying  toxic  products  in  the  intestine,  and  also  that  it  can 
hinder  the  development  of  gall-stone  disease  (see  Chapter 
XXXIX). 

Not  only  meat  used  in  abundance,  but  also  various  kinds  of 
spices,  condiments  and  stimulants  may  be  very  injurious,  espe- 
cially alcohol,  if  taken  in  large  quantity.  Gin  and  brandy  are 
the  most  deleterious  in  their  action.  Wines  containing  little  alco- 
hol are  less  harmful,  but  acid  or  strong  white  wines  may  injure 
the  liver-tissue. 

The  well-being  of  this  organ  is  essentially  dependent  on 
the  good  condition  of  various  other  organs  with  which  it  stands 
in  very  close  relation,  in  particular  the  intestines,  for  instance.  It 
is  from  here  that  most  of  the  toxic  products  enter  the  liver, 
either  by  the  portal  vein  or  through  the  choledochus.  The  intes- 
tine always  contains  myriads  of  microbes,  which  may  enter  the 

(155) 


156  Old  Age  Deferred. 


liver  either  by  the  blood  or  the  bile,  and  thus  provoke  very  impor- 
tant changes  in  the  liver-tissue.  Professor  Adami,1  of  Montreal, 
found  colon  bacilli  in  a  cirrhotic  liver. 

It  follows,  therefore,  that  we  must  maintain  the  intestine  in 
the  best  possible  condition,  and  avoid  constipation  and  stagnation 
of  faecal  matters,  with  the  augmentation  of  toxic  products.  That 
constipation  is  very  deleterious  to  the  liver  can  be  best  shown 
by  the  fact  that  very  often  affections  of  the  liver  and  bile-ducts, — 
and  especially  gall-stone  disease, — are  developed  in  persons 
suffering  from  habitual  constipation.  The  best  treatment  for 
these  liver  affections  is  a  purging  treatment,  and  it  is  mainly  on 
account  of  their  action  in  this  manner  that  certain  alkaline  min- 
eral waters  have  attained  so  great  a  fame ;  in  addition,  due  to 
increased  peristalsis,  the  circulation  of  the  bile  is  enhanced. 

Proper  movements  of  the  bowel  are  indispensable  to  a  sound 
condition  of  the  liver  and  for  the  prevention  of  hepatic  disease, 
and  we,  therefore,  refer  the  reader  to  the  chapter  that  deals  in 
detail  with  the  prevention  and  treatment  of  constipation. 

Not  only  the  intestine,  but  the  stomach  also,  must  be  in- 
good  condition.  It  has  been  noted  by  Bouchard  and  Hanot  that 
chronic  gastric  and  intestinal  troubles  are  apt  to  cause  enlarge- 
ment of  the  liver.  Bouchard  has  found  an  enlarged  liver  in  23 
per  cent,  of  his  cases  of  dilatation  of  the  stomach.  Hanot  and 
Boit2  have  shown  experimentally  that  the  different  acids  formed 
in  the  gastro-intestinal  tract  are  able  to  produce  a  genuine  cir- 
rhosis of  the  liver.  Therefore  acid  fermentation  must  be  care- 
fully avoided ;  and  to  prevent  such  fermentation  in  some  degree 
in  the  stomach  and  in  the  intestine,  it  is  necessary  to  masticate 
the  food  thoroughly,  as  will  be  shown. 

Another  very  important  organ,  the  sound  condition  of  which 
is  of  great  importance  to  the  liver,  is  the  pancreas.  It  has  been 
found  by  several  authors,  particularly  by  Steinhaus,3  in  his  in- 


1  Quoted  from  Quincke :     "Diseases  of  the  Liver"  in  Nothnagel's  "Practice." 

2  Hanot  and  Boit:     Congresso  Med.  Internat.  di  Roma,  1894. 

3  Steinhaus:     Deutsches  Archiv  fiir  klin.  Medicin,  1902. 


The  Hygiene  of  the  Liver. 


vestigation  of  some  40  cases  of  hepatic  cirrhosis,  that  the  pan- 
creas is  also  affected  in  each  case  of  this  type;  and  we  further 
know  that  after  disease  of  the  pancreas,  as  in  diabetes,  for 
example,  the  liver  is  also,  as  a  rule,  altered.  Thus  these  two 
organs  are  in  close  relationship. 

As  pancreatic  diseases  are  among  the  most  difficult  to  diag- 
nose, and  people  suffering  from  them  live  and  die,  as  do  also  many 
diabetics,  without  their  particular  state  having  been  recognized, 
so,  the  rational  treatment  of  these  diseases  being  still  imperfect, 
we  cannot  offer  advice  in  regard  to  their  prevention.  But,  at 
any  rate,  the  safest  course  will  be  moderation  in  diet,  especially 
fatty  food,  which  exacts  the  active  co-operation  of  the  pancreas. 
As  in  the  case  of  all  other  organs,  long-continued  overwork  will 
exhaust  this  gland,  and  thus  induce  a  diseased  condition.  Mod- 
eration in  diet  will  be  the  best  policy  for  the  pancreas,  as  also 
for  the  liver;  and  to  maintain  these  organs  in  sound  working 
order,  meat  in  particular  should  only  be  taken  in  small  quantities, 
and  fat  also  should  not  be  partaken  of  in  large  amount. 

Milk  and  vegetable  food,  with  but  little  meat,  and  that  pref- 
erably as  fish,  will  certainly  furnish  the  best  diet  to  avoid  dis- 
eases of  the  liver.  As  Quincke4  mentions,  experience  shows  also 
that  water  in  large  quantities,  especially  certain  alkaline  saline 
waters,  can  increase  the  flow  of  the  bile;  and  therefore,  as  also 
for  other  reasons  mentioned  in  this  book  in  Chapters  XXXIV 
and  XLI,  water  should  be  drunk  in  sufficient  quantity  every  day. 
The  alkaline  waters  referred  to  are  certainly  superior  in  their 
action  to  ordinary  water,  especially  those  kinds  which  at  the 
same  time  cause  purging. 

Hot  climates  have  a  deteriorating  effect  on  the  liver.  We 
have  often  noted  the  great  frequency  of  liver  complaints  under 
these  conditions,  and  we  have  never  had  a  patient  from  the  hot 
parts  of  Mexico  who  has  not  had  a  hypertrophied  liver.  We  are 
inclined  to  believe  that  it  is  not  so  much  the  climate  as  faults  in 
hygiene,  especially  in  diet  and  in  the  use  of  stimulants,  which  are 

4  Quincke:     "Diseases  of  the  Liver,"  in  Nothnagel's  "Practice,"  1907. 


158  Old  Age  Deferred. 


the  cause  of  such  a  condition  in  Europeans  residing  in  tropical 
climates. 

A  vegetarian  diet  is  certainly  the  best  in  tropical  countries, 
as  we  personally  found  during  a  stay  in  Southern  Florida,  Texas, 
and  Mexico.  Just  as  for  the  kidneys,  so  for  the  liver,  a  bath,  and 
particularly  a  sweat-bath,  is  of  great  benefit,  since  by  means  of 
it  toxic  products  may  be  eliminated  which  would  otherwise 
be  carried  to  the  liver. 

We  have  found  these  baths  to  be  of  great  benefit  in  liver 
diseases,  and  considering  the  amelioration  of  the  processes  of 
oxidation  brought  about  by  such  baths,  it  seems  highly  probable 
tnat  they  are  capable  of  improving  also  the  working  condition  of 
a  liver  not  as  yet  diseased. 

In  general,  it  is  our  opinion  that  to  prevent  disease  in  an 
organ  the  surest  method  is  to  use  those  means  through  which  that 
organ,  when  diseased,  is  found  to  benefit.  Of  course  this  is  only 
meant  as  a  general  statement ;  but  in  the  children  of  those  suffer- 
ing from  liver  complaints  such  preventive  treatment  is  particularly 
indicated,  as  these  conditions,  we  have  found,  are  most  frequently 
inherited.  We  have  treated  cases  where  three  or  four  genera- 
tions of  one  family  had  been  sufferers  from  the  same  complaint. 

Here,  as  always,  let  us  follow  the  wise  precept:  "Preven- 
tion is  better  than  cure." 


CHAPTER  XV. 

On  the  Destruction  of  Toxic  Products  by  the 
Adrenals. 

There  is  ample  evidence  in  support  of  the  contention  that 
the  adrenals  play  an  important  part  in  the  destruction  of  toxic 
products  in  the  body.  As  long  ago  as  1853,  one  of  the  leading 
authorities  on  the  adrenals  as  ductless  glands,  Brown-Sequard, 
noticed  that  the  blood  of  animals  without  adrenals  was  more 
toxic  than  that  of  animals  the  adrenals  of  which  had  not  been 
removed. 

Langlois  and  Abelous1  confirmed  the  conclusions  of  Brown- 
Sequard.  They  also  established  the  fact  that  the  blood  and  mus- 
cular extracts  of  frogs  whose  adrenals  had  been  removed,  were 
toxic,  and  contained  a  poison  of  the  nature  of  curare.  The 
animals  died  from  auto-intoxication,  and  these  savants  came  to 
the  conclusion  that  the  adrenals  were  created  to  neutralize  or  de- 
stroy poisons  which  are  evolved  during  muscular  work.  Frogs 
from  which  the  adrenals  had  been  removed  showed  also  lessened 
resistance  to  muscular  fatigue.  Similar  results  have  been  ob- 
served by  Langlois  in  the  case  of  other  animals:  rabbits,  dogs, 
guinea-pigs,  etc.  Albanese2  also  found  that  animals  operated 
on  as  above  exhibited  more  fatigue  than  those  whose  adrenals 
had  been  allowed  to  remain  intact.  The  recent  labors  of  Sajous 
which  have  shown  conclusively  that  the  adrenals  furnish  to  the 
blood  one  of  its  important  immunizing  constituents  explain  all 
the  above  observations. 

The  fact,  observed  by  all  these  authorities,  that  when  one 


1  Abelous  et  Langlois:  Archives  de  physiologie  norm,  et  path.,  p!  267,  vol. 
iii,  1892,  and  "Travaux  de  Laboratoire,"  Lancet,  August  20,  1898;  Societe  de 
biologie,  1892. 

2  Albanese:     Archiv.  Ital.  di  Biologia,  p.  338,  1892. 

(159) 


160  Old  Age  Deferred. 


of  the  adrenals  is  removed  the  other  becomes  hypertrophied, 
sometimes  to  a  great  extent,  seems  also  to  point  to  the  conclu- 
sion that  greater  demands  are  made  on  the  gland  that  remains, 
the  hypertrophied  condition  of  which  appears  to  be  due  to  the 
increased  work  required  of  it  in  protecting  the  body  from 
infection. 

That  these  organs  really  assist  in  the  defense  of  the  body 
against  the  attacks  of  microbes  or  the  introduction  into  it  of 
certain  toxic  products  can  be  best  demonstrated  by  the  fact  that 
after  such  infections  the  adrenals  are,  as  a  rule,  altered,  showing 
that  a  pronounced  reaction  antagonistic  to  these  agencies  has 
occurred. 

It  has  thus  been  proved  by  a  succession  of  authors:  Char- 
rin,3  Langlois,  Roux,  Yersin,  Professor  Roger,  and  more  recently 
by  Oppenheim  and  Loeper,4  that  in  experimental  or  in  sponta- 
neous infectious  diseases  the  adrenals  present  important  altera- 
tions as  a  result  of  the  reaction  against  infection. 

Oppenheim  and  Loeper  found  that  important  changes  fol- 
lowed upon  experimental  infectious  diseases;  for  example,  after 
infection  by  the  bacilli  of  diphtheria  or  anthrax,  or  by  the  pneu- 
mococcus;  also  in  such  infectious  diseases  as  diphtheria,  pneu- 
monia, small-pox,  typhoid  fever,  etc. ;  and  also  after  experimental 
poisonings,  as  with  arsenic,  phosphorus,  or  mercury.  There 
occurred  leucocytic  reaction,  diffuse  diapedesis,  or  infectious  nod- 
dules,  and  also  a  congested  condition  of  the  adrenals,  sometimes 
so  marked  that  haemorrhage  took  place,  with  complete  destruction 
of  the  parenchymatous  tissue  of  the  glands. 

Very  important  are  the  conclusions  of  Oppenheim,5  that 
when  animals  have  received  poisonous  products,  together  with 
adrenal  extracts,  after  having  previously  lost  these  glands  by 
operation,  such  animals  show  a  longer  survival,  sometimes  even 
of  indefinite  duration,  as  compared  with  animals  without  adrenals 

3(Jharrin:         "Les  defenses  naturelles  de  Forganisme,"  Paris,  1898;  C.  R. 
Soc.  de  biologie,  1892. 

4  Oppenheim  et  Loeper:  C.  R.  Soc.  de  biol.,  22  mars,  1901. 

5  Oppenheim:    "Les  capsules  surrenales,  "These  de  Paris,  1902. 


Destruction   of   Toxic  Products  by  the  .  Utrcnals.         161 

to  which  have  been  administered  the  same  toxic  products,  but 
without  adrenal  extracts. 

With  phosphorus  and  urinary  poisons  in  particular,  this 
author  has  obtained  most  striking  results  from  the  injection  into 
animals  of  adrenal  extracts  at  the  same  time  as  the  poisonous 
substances. 

Oppenheim  comes  to  the  same  conclusion  as  Abelous,  Char- 
rin,  Langlois  and  Sajous:  that  the  adrenals  play  a  great  role  in 
the  destruction  or  neutralization  of  microbic  or  other  poisons 
introduced  into  the  system. 

We  are  thus  in  possession  of  powerful  arguments  in  support 
of  the  presumption  that  the  adrenals  are  antitoxic  glands.  The 
fact,  found  by  Langlois,  that  the  adrenals  contain  less  adrenalin 
after  experimental  infectious  diseases,  and  that  established  by 
Luksch,  that  after  certain  experimental  infectious  diseases  such 
as  diphtheria,  typhoid,  or  tuberculosis,  the  extract  from  the 
adrenals  no  longer  produces  an  increased  blood-pressure,  do  not 
seem  to  us  sufficient  to  invalidate  our  belief  in  the  antitoxic 
properties  of  these  glands ;  for  here  we  are  witnessing  the  same 
occurrence  as  has  been  previously  noted  in  reference  to  the  thy- 
roid,— that  the  functional  hyperactivity  of  the  gland  may  be 
followed  by  its  exhaustion. 

Moschini,  Nicholas,  and  Bonnamour  have  also  found  his- 
tological evidences  in  the  adrenals  in  infectious  diseases  indicating 
a  hyperactivity  of  these  glands. 

The  fact  that  different  toxic  products,  such  as  alcohol,  can 
produce  alterations  in  the  adrenals,  indicates  also  a  role  of  these 
glands  in  defending  the  body  against  toxic  doses  of  this  sub- 
stance (see  Chapter  III). 

It  was  found  by  Aubertin6  and  other  authors  that  there  is 
a  hyperplasia  of  the  adrenals  after  experimental  intoxication  of 
the  guinea-pig  by  alcohol.  Bernard  and  Bigart  found  important 
alterations   of   the    adrenals    after    experimental    poisoning   by 


6  Aubertin :  C.  R.  Soc.  de  biologie,  22  juillet,  1902. 

ll 


162  Old  Age  Deferred. 


mercury,  arsenic,  lead,  etc.  As  shown  by  Professor  Sajous,7 
various  drugs  act  on  these  glands,  and  he  attributes  the  rise  of 
blood-pressure  therefrom  to  the  action  of  such  drugs  on  the 
adrenals,  whose  function,  as  is  well  known,  is  to  raise  the  blood- 
pressure.  We  can  thus  understand  how  if  alcohol  be  taken  in 
large  quantities  it  is  able  to  produce  atheroma  and  arteriosclerosis, 
as  are  also  other  toxic  bodies,  such  as  nicotine. 

It  is  well  known  that  arteriosclerosis  is  frequent  in  great 
smokers.  It  has  been  found  by  several  authorities,  among  them 
Borylac,  that  inhalation,  or  mastication,  of  tobacco  produces 
atheroma,  and  by  Boverie  and  Loeper8  that  similar  changes 
have  followed  experiments  with  tobacco  or  ergotin.  Very  im- 
portant data  have  also  been  established  by  Drs.  Isaac  Adler  and 
Hensel,  of  New  York,9  who  have  found  that  atheromatous  alter- 
ations of  the  aorta  can  be  produced  experimentally  by  powerful 
doses  of  nicotine.  Such  alterations  were  similar  to  those  effected 
by  adrenalin,  but  were  neither  so  constant,  nor  so  marked. 

These  experimental  facts,  together  with  observations  by 
Dr.  Sajous,  prove  that  the  atheromatous  condition  brought  about 
after  using  certain  drugs,  such  as  alcohol  and  tobacco,  can  be 
ascribed  to  the  adrenals.  Josue,  in  1893,10  showed  that  by  inject- 
ing adrenal  extracts  (solution  1 :  1000)  into  the  veins  of  a  rabbit, 
atheromatous  patches  of  the  aorta  will  appear  after  five  or  six 
weeks.  The  changes  described  by  Adler  and  Hensel  from  the 
effects  of  nicotine  confirm  the  probability  that  tobacco  acts  on 
the  adrenals  first,  then,  by  their  medium,  on  the  blood-vessels 
(see,  also,  Chapter  XLIII). 

The  above  observations  show  that  the  same  is  also  probable  in 
the  case  of  alcohol,  to  which  we  may  add  a  case  of  Widal  and 
Boivin,  who  found  in  a  young  woman  dipsomaniac  a  hyperplasia 
of  the  adrenals  and  atheroma  of  the  aorta ;  and  to  complete  the 
value  of  these  observations  we  subjoin  those  of  a  series  of  cases 

7  Sajous :  Log.  eit. 

8  Societe  d'Anatomie,  Mai  31,  1907. 

9  Deutsche  Med.  Woehenschrift  8,  1906. 
IOC.  R.  Soc.  biologie,  Nov.  14,  1893. 


Destruction  of  Toxic  Products  by  the  Adrenals.         163 

of  atheroma  by  Joshua,  in  three  of  which  a  hyperplastic  condition 
of  the  adrenals  was  found. 

It  follows  logically  from  the  foregoing  effects  of  alcohol  and 
tobacco,  that  we  must  avoid  large  quantities  of  these  substances  if 
we  desire  to  keep  in  a  normal  condition  the  heart  and  blood- 
vessels, upon  the  perfect  state  of  which  depends,  in  a  great  degree, 
our  chances  of  a  long  life  and  extended  youthfulness. 

We  will  deal  further  with  the  latter  points  in  the  following 
chapter. 


CHAPTER  XVI. 

Hygiene  of  the  Adrenals  and  of  the  Circulatory  Sys- 
tem— A  Few  Remarks  on  the  Cause,  Prevention, 
and  Treatment  of  Arteriosclerosis. 

In  order  to  obtain  the  best  hygienic  condition  of  the  circu- 
latory system,  it  is  indispensable  to  avoid  all  that  are  harmful  to 
the  adrenals.  There  can  no  longer  be  any  doubt  that  these  glands 
exercise  a  controlling  influence  on  the  heart  and  the  whole  circu- 
latory system.  They  are  in  intimate  relation  with  the  principal 
nerves  that  regulate  the  heart:  the  sympathetic  and  the  vagus. 
Thus,  for  instance,  emotions  that  act  on  these  nerves  excite 
through  them  a  hypersecretion  of  the  adrenals  and  a  contraction 
of  the  small  blood-vessels,  with  a  rise  in  the  blood-pressure.  By 
the  hyperactivity  of  these  glands  their  secretion,  in  larger  quan- 
tity than  usual,  is  thrown  out  into  the  system,  producing  toxic 
effects  which  result  in  an  atheromatous  condition  of  the  arteries. 
According  to  our  present  knowledge,  we  imagine  this  athero- 
matosis to  be  due  to  the  toxic  effect  of  the  adrenals  quite  inde- 
pendently of  the  increase  in  the  blood-pressure,  for  it  has  been 
distinctly  shown  that  even  substances  which  diminish  blood- 
pressure,  such  as  amyl  nitrite,  for  example,  are  also  capable  of 
producing  atheroma.  The  toxic  effects  of  adrenalin  are  proved 
by  the  experiments  of  Amberg1  in  the  laboratories  of  the  Johns 
Hopkins  University. 

We  must  especially  insist  on  the  fact  that  high  blood-pres- 
sure is  not  a  condition  essential  to  arteriosclerosis.  It  has  been 
shown  by  Sawada,la  Groedel,2  and  Ferranini,3  through  measuring 

i  Amberg:     Archives  Internationales  de  Pharmakodynamie  et  Therapie, 
1905. 

la  Deutsche  Med.  Wochenschrift,  No.  12,   1907. 

2  Congress  fiir  Innere  Medicin,  1907. 

3  Grom.  Int.  della  Soc.  Med.,  xxvi. 

(164) 


Prevention  and  Treatment  of  Arteriosclerosis.  165 

the  blood-pressure  by  Riva-Rocci's  instrument,  that  numerous 
cases  of  arteriosclerosis  can  arise  without  any  increase  at  all  in 
the  blood-pressure.  According  to  Professor  Romberg,4  there  is 
only  high  blood-pressure  in  such  cases  of  arteriosclerosis  where 
there  is  a  diseased  condition  of  the  kidneys.  According  to  this 
leading  authority  on  heart  diseases,  high  blood-pressure  is  one 
of  the  earliest  symptoms  of  kidney  complication  in  arterioscle- 
rotic persons.  We  believe  that  the  high  blood-pressure  found  in 
kidney  diseases  may  be  brought  into  correlation  with  the  previous 
statement,  by  the  fact  that  in  such  conditions,  and  especially  in 
sclerosis  of  the  kidneys,  the  adrenals,  if  examined,  are  frequently 
found  to  be  hypertrophied,  as  was  noted  by  Parkes  Weber,5 
Lemaire,  and  in  four  cases  of  Troin  and  Rivet.6  At  the  last  Con- 
gress of  German  Physicians  and  Naturalists  in  Dresden,  1907,  it 
was  proved  by  Schur  and  Wiesel,  as  also  in  their  previous  com- 
munications, that  the  blood  of  patients  affected  with  kidney 
diseases  contained  the  characteristic  substance  that  gives  the 
adrenalin  reaction  with  perchloride  of  iron,  and  produced 
mydriasis  if  dropped  into  a  frog's  eyes. 

It  is  of  singular  interest  that  all  those  agencies  that  pro- 
duce a  hypersecretion  of  the  adrenals  are  the  same  which 
are  known  to  be  harmful  in  causing  arteriosclerosis.  In  the 
front  rank  of  such  are  tobacco,  alcohol,  and  different  kinds  of 
poison,  such  as  lead,  mercury,  etc. ;  also  infectious*  diseases, 
especially  syphilis,  the  important  role  performed  by  which,  in  the 
production  of  arteriosclerosis,  has  been  treated  of  very  com- 
petently by  Professor  Edgreen,7  of  Stockholm,  and  Darier,  of 
Paris.  Arteriosclerosis  can  also  be  produced  very  frequently  by 
abundant  meat  food  and  by  strong  tea  or  coffee.  There  is  as 
yet  no  scientific  proof  to  show  that  abundant  meat  food  has  the 
same  deleterious  action  on  the  adrenals  as  upon  the  thyroid, 


4  Lehrbuch  der  Krankheiten  destergens  imd  der  oxlutgefiire.      Stuttgart, 
1906. 

5  Parkes  Weber :     Transact.  Path.  Society,  London,  lviii,  3. 

6  Gazette  des  hopitaux,  Jiiin  14,  1906. 

7  "Die  Arteriosclerose,"  Leipzig,  1898. 


166  Old  Age  Deferred. 


ovaries,  pituitary  body,  pancreas,  liver,  kidneys,  etc.,  upon  which 
we  have  enlarged  in  previous  chapters  of  this  book;  and,  more- 
over, we  have  no  knowledge  of  any  work  written  on  this  subject ; 
but  as  such  a  diet  is  very  efficacious  in  producing  a  sclerotic  con- 
dition of  the  kidneys,  it  may,  for  these  reasons  alone,  tend  to 
further  the  development  of  arteriosclerosis,  considering  that  so 
often  in  such  conditions  both  kidneys  and  adrenals  are  found  in  a 
hypertrophic  condition.  This  disease  may  be  produced  by 
alcohol,  tea,  and  coffee,  by  causing  a  great  variation  in  the  tone 
of  the  capillaries.  According  to  Professor  Romberg  and  others, 
it  remains  to  be  proved  whether  they  affect  the  adrenals  at  all; 
but  we  have  already  shown  what  their  action  is  on  the  kidneys. 

To  keep  the  adrenals  in  good  condition  and  thus  prevent 
arteriosclerosis,  it  is  necessary  to  avoid  all  the  above  harmful 
agencies.  It  is  true  that  there  are  some  people  who  can  enjoy 
these  things  in  large  quantities  with  impunity  and  without  in- 
jurious effects  until  they  reach  a  considerable  age ;  but  it  is 
different  when  they  all  act  together.  Especially  deleterious  are 
mental  emotions,  grief,  and  sorrow,  on  which  we  have  dwelt  in 
the  introduction  to  this  chapter,  and  on  the  effects  of  which  we 
have  previously  remarked;  they  produce  a  great  variation  in 
the  tone  and  calibre  of  the  blood-vessels.  We  will  therefore  en- 
deavor to  treat  of  the  prevention  of  a  prolonged  continuance  of 
this  most  disastrous  agency  in  our  chapters  on  the  hygiene  of 
the  mind.  Emotions  of  a  sexual  character  are,  perhaps,  more 
than  emotions  from  other  sources,  disastrous  to  the  heart  and 
blood-vessels,  as  shown  by  the  fact,  which  may  often  be  observed, 
that  persons  addicted  to  sexual  excitations  frequently  die  from 
sclerosis  of  the  coronary  arteries.  That  the  sexual  glands  are  in 
intimate  relations  with  the  heart,  which  can  often  be  irritated  in 
consequence  of  changes  in  these  glands,  especially  in  women, 
has  been  already  mentioned. 

We  should  like  to  add  that,  as  the  above  agencies  are  also 
harmful  to  the  thyroid  gland,  the  antagonist  of  the  adrenals, 
its  degeneration  can  further  the  development  of  arteriosclerosis 


Prevention  and  Treatment  of  Arteriosclerosis.  107 

in  the  same  way  that  Eiselsberg  produced  an  atheromatosis  of 
the  aorta  in  dogs  after  extirpating  the  thyroid  gland.  According 
to  Minnich,  arteriosclerosis  is  very  common  in  people  with  goiter, 
appearing  in  them  at  a  very  early  age.  Fries  and  Pineles  found 
that  alterations  of  the  blood-vessels  occurred  in  goats  after  extir- 
pation of  their  thyroid  gland. 

Since  arteriosclerosis  is  so  frequent  in  old  age  it  must  be  due 
to  the  degeneration  of  the  thyroid  and  also  to  the  aggregation  of 
all  the  above-named  harmful  agencies  during  a  prolonged  period. 
To  avoid  it,  and  also  premature  old  age,  it  is,  therefore,  most 
essential  to  guard  against  all  agencies  harmful  to  the  thyroid  and 
adrenals,  to  which  we  have  referred  above;  and  this  is  the  best 
basis  for  the  rational  treatment  of  arteriosclerosis.  It  is  most 
fortunate  that  Dellamare  discovered  in  old  age  a  hypertrophy  of 
the  adrenals.8 

All  this  is  greatly  strengthened  by  the  recent  investigations 
of  Sajous,  which  show  that  besides  its  action  on  the  blood-pres- 
sure and  the  heart,  the  adrenal  secretion  actually  supplies  the 
substance  which  in  the  lungs,  takes  up  the  oxygen  from  the  air 
to  sustain  life  in  all  our  tissues.  It  thus  becomes  evident  that 
harm  to  our  adrenals  is  bound  to  shorten  life. 

To  recapitulate :  There  exist  two  chief  agencies  for  the  pro- 
duction of  arteriosclerosis:  I.  A  hyperactivity  of  the  adrenals, 
causing  a  rise  in  blood  pressure.  2.  A  degeneration '  of  the 
thyroid  gland,  which,  when  normal,  antagonizes  the  first  by 
lowering  the  blood  pressure.  Although  from  the  above  men- 
tioned facts  high  blood  pressure  cannot  be  considered  as  the  chief 
cause  of  arteriosclerosis,  still  no  doubt  it  certainly  contributes  to 
it;  for  each  time  that  there  is  a  rise  in  the  blood  pressure  more 
blood  is  forced  through  the  arteries,  thereby  causing  them  to 
dilate;  and  after  a  repeated  number  of  such  dilatations  the  elas- 
ticity of  the  vessels  will  eventually  be  impaired,  especially  so  in  the 
aged,  where  one  part  of  the  elastic  fibers  is  already  replaced  by 

8  "Recherches  sur  la  senescence  des  glandes   surrenales,"  Soc  biologic,  17 
Oct,  1903. 


168  Old  Age  Deferred. 


connective  tissue.  As  a  result  of  the  arteriosclerosis  the  passage 
of  blood  through  the  capillaries  will  be  impeded,  and  in  conse- 
quence the  work  of  the  heart  will  be  increased;  likewise  the 
nutrition  of  the  walls  of  the  vessels  will  be  diminished.  The  best 
preventatives  of  arteriosclerosis  will  therefore  be:  i.  To  avoid 
all  agencies  which  may  tend  to  cause  excessive  activity  of  the 
adrenals ;  and  2.  To  increase  the  activity  of  trie  thyroid. 

Moderation  in  food  is  necessary  above  all  things,  for  much 
food  causes  an  increase  in  the  abdominal  circulation  and  a  larger 
amount  of  blood  to  be  carried  through  the  vessels ;  if  the  food 
consists  of  much  meat,  then  its  viscosity  is  augmented,  as  pre- 
viously stated,  which  indicates  that  a  vegetable  diet,  with  milk, 
and  little  or  no  meat,  is  the  best ;  but  too  large  quantities  of  milk 
should  not  be  taken  at  one  time. 

Much  bodily  and  other  exercises,  in  excess,  such  as  too  much 
climbing,  should  be  avoided,  as  they  promote  arteriosclerosis  by 
frequent  excitation  of  the  splanchnics  and  adrenals.  As  Romberg 
observed,  there  is  sclerosis  of  the  arteries  in  the  extremities  of 
persons  who  do  much  physical  labor,  and  Remlinger9  found  the 
same  in  the  lower  extremities  of  peasant  women  who  walked  a 
great  deal. 

Not  only  by  a  diet,  chiefly  vegetarian,  is  the  viscosity  of  the 
blood  diminished  and  the  circulation  facilitated  as  found  by 
Determann,  but  also  by  means  of  iodine  administered  in  the 
shape  of  iodide  of  potassium  or  iodide  of  sodium.  This  has  been 
proved  by  the  experiments  of  Ottfried,  Miiller,  and  Inada.10  For 
many  years  it  has  been  well  known  that  iodine  can  greatly  benefit 
the  condition  of  arteriosclerotic  persons.  In  combination  with  a 
preparation  of  iodine,  Professor  Senator11  favors  the  use  of 
nitrites,  and  Professor  Huchard  also  recommends  nitroglycerine 
in  the  intervals  between  the  iodide  treatment.  Besides  inorganic 
iodine,  it  would  appear  to  us  logical  to  try  organic  iodine  prepara- 


9  Remlinger:     "Dissertation  on  Arteriosclgrose,"  Marburg,  1905. 

10  Preface  of  Romberg:  Deutsche  Med.  Wochenschrift,  No.  78,  1904, 

11  "Therapie  der  Gegenwart,"  March,  1907. 


Prevention  and  Treatment  of  Arteriosclerosis.  169 

tions,  such  as  thyroid  extracts,  the  principal  element  of  which  is 
iodine.  For  the  above  reasons  it  is  also  necessary  to  take  special 
care  of  the  condition  of  the  kidneys,  which  can  be  done,  as  we 
have  shown,  by  hygienic  and  dietetic  measures,  already  described 
in  the  special  chapters  of  this  work.  An  improvement  in  the 
condition  of  the  kidneys,  and  probably  also  in  the  arteriosclerosis, 
may,  in  our  judgment,  be  obtained  by  the  administration  of 
kidney  extracts,  with  which  we  will  deal  more  fully  in  the 
chapter  on  the  treatment  of  old  age  by  organic  extracts. 

According  to  Edgreen,  about  25  per  cent,  of  the  cases  of 
arteriosclerosis  is  caused  by  alcohol.  It  acts  by  causing  a  con- 
striction of  the  small  vessels  (Traube),  just  as  does  adrenalin. 

But  much  more  harmful  in  the  production  of  arteriosclerosis 
is  tobacco.  According  to  Claude  Bernard,  Huchard,  Basch, 
Oser,  Isaac  Adler,  and  Hensel,  tobacco  produces  a  constriction 
of  the  small  blood-vessels.  Thus  nicotin,  adrenalin  and  alcohol 
have  similar  actions,  which  also  corresponds  to  the  observations 
of  Sir  Lauder  Brunton.  We  have  had  a  great  many  smokers 
among  our  arteriosclerotic  patients;  but,  on  the  other  hand,  we 
quote  further  on  the  cases  of  some  great  smokers  who  lived  to  a 
very  old  age  as  we  have  seen.  But  this  latter  class  is  not 
numerous. 

Similarly,  the  hygiene  of  the  intestines  is  of  the  utmost 
importance,  especially  as  poisons  generated  in  the  intestines 
play  a  leading  part  in  causing  arteriosclerosis,  according  to 
Huchard,  Senator,  and  others.  We  must  take  great  care  to  have 
a  daily  evacuation  of  the  bowels,  and  especially  to  prevent  flat- 
ulence, for  this  distention  of  the  colon  or  the  stomach,  by  carrying 
the  diaphragm  upward,  may  interfere  with  the  expansion  of  the 
lungs  and  thus  produce  a  mechanical  hindrance  to  the  movements 
of  the  heart  and  a  free  circulation  of  the  blood.  Those  with  a 
tendency  to  angina  pectoris  must  specially  avoid  such  dangerous 
courses.  Hill  climbing,  during  which  not  infrequently  such  peo- 
ple suffer  sudden  death,  should  also  be  avoided.  More  than  from 
I  to  iJ/2  liters  of  liquids  per  day  should  not  be  allowed. 


CHAPTER  XVII. 

The  Elimination  of  Toxic  Products  Through  the  Intes- 
tines and  the  Improvement  of  This  Function. 

The  intestines  contain  billions  and  billions  of  microbes,  their 
number  increasing  downward  throughout  the  length  of  the  intes- 
tine. The  duodenum  contains  the  least,  and  in  some  parts  of  it 
there  are  none  at  all. 

The  presence  of  these  bacteria  is  a  great  necessity  to  us, 
as  without  their  assistance  we  could  not  exist,  for  they  take  an 
active  part  in  intestinal  digestion  and  help  to  form  the  inter- 
mediate substances,  especially  from  albuminous  food  and  fat, 
for  our  nutrition.  They  also  assist  fermentation  and  thus  induce 
a  better  peristalsis  of  the  intestines,  by  which  the  contents  are 
expressed. 

That  animals  cannot  exist  without  cultures  of  bacteria  in  the 
intestines  is  shown  by  the  experiment  of  Schottelius,  who  dem- 
onstrated that  young  chickens  could  not  thrive  on  a  sterilized 
nutrition,  and  Nuttall  and  Thierfelder  had  great  trouble  in  keep- 
ing their  guinea-pigs  alive  when  feeding  them  for  a  time  on 
sterilized  milk. 

All  those  bacteria  which  are  found  in  the  intestines  are,  we 
may  say,  innocuous ;  they  assist  digestion  and  do  no  harm.  But 
among  such  are  often  virulent  bacilli  against  which,  under  nor- 
mal circumstances,  we  are  well  guarded,  as  the  epithelium  of  the 
intestines  is  so  wonderfully  arranged  that  so  long  as  it  is  in 
a  healthy  condition  it  does  not  admit  the  passage  of  these 
microbes;  but  in  the  aged,  or  in  those  exhausted  by  debauchery 
or  previous  disease,  or  when  there  is  an  inflamed  condition  of 
the  intestines,  stagnation  of  hard  masses  of  faeces  for  a  very  long 
time  cause  mechanical  lesions  of  the  epithelium  when,  conditions 
(170) 


Elimination  of  Toxic  Products  Through  Intestines.       171 

now  having  changed,  nothing  will  prevent  these  microbes  from 
entering  the  walls  of  the  intestines  and  either  cause  disease,  like 
typhoid  or  tuberculosis,  or  from  passing  through  and  entering 
into  the  blood. 

Besides  the$e  dangerous  bacteria  many  other  harmful  sub- 
stances pass  from  the  stomach  down  into  the  intestines,  whence 
they  are  taken  up  by  the  portal  vein  and  brought  to  the  liver. 
When  the  latter  is  in  good  condition  so  much  the  better  for  us, 
but  when  they  arrive  in  too  large  quantities,  or  when  the  liver  is 
more  or  less  degenerated,  as  in  old  people,  drunkards,  gourmands, 
etc.,  then  trouble  arises. 

When  the  number  of  bacteria  in  the  intestines  is  much 
greater  than  usual,  certain  dangers  arise  from  such  a  condition, 
as  thereby  the  immigration  of  bacilli  into  the  bile-duct  is  facili- 
tated causing  inflammation  of  the  gall-ducts  and  gall-bladder, 
and  subsequently  gall-stone  disease.  Further  consequences  of 
such  a  condition  may  be  the  closure  of  the  bile-duct,  and  then 
no  bile  can  reach  the  intestines.  The  presence  of  bile,  however, 
is  very  important,  for,  according  to  current  opinion,  this  exerts 
an  influence  on  the  checking  of  putrefaction  in  the  intes- 
tines. Bile  is  a  natural  antiseptic  of  great  efficacy,  and  has  also 
a  stimulating  effect  on  the  nerves  of  the  intestines,  promoting 
their  peristaltic  movements. 

It  would,  therefore,  greatly  interfere  with  the  useful  work 
of  those  organisms  normally  present  if  we  permitted  the  forma- 
tion of  enormous  quantities  of  bacteria,  especially  of  such  as  are 
harmful  to  us;  so  we  must  endeavor  to  eliminate  them  and  not 
give  them  the  opportunity  to  turn  against  us,  and  we  must  do  all 
in  our  power  to  keep  the  peristalsis  of  the  bowels  in  good  working 
order  so  as  to  prevent  any  stagnation  of  their  contents,  as  such  a 
stagnation,  in  addition  to  favoring  the  growth  of  bacteria,  also 
facilitates  the  development  of  auto-intoxication.  Even  if  it  is 
true  that  most  of  the  end-products  of  proteid  food  in  our  intes- 
tines, like  indol  and  skatol,  are  not  able  to  produce  severe  poison- 
ing if  injected  into  other  animals ;  still  there  is  no  doubt  that  in 


172  Old  Age  Deferred. 


medical  practice  not  infrequently  cases  are  observed  where  the 
retention  of  all  these  products  together  results  in  very  grave 
conditions.  Thus  Ewald1  has  published  the  case  of  a  woman 
who,  for  about  a  month,  retained  the  contents  of  the  bowels  and 
in  consequence  presented  a  serious  condition  of  intoxication; 
after  eliminating  a  large  quantity  of  faeces — pitch  dark — she 
recovered  and  the  symptoms  of  intoxication  disappeared.  Sena- 
tor also  published  a  very  interesting  case  of  auto-intoxication 
with  hydrothionuria. 

We  often  have  occasion  to  note  cases  of  persons  having  no 
bowel  action  for  two  to  three  days,  who  then  complain  of  head- 
ache, loss  of  appetite,  and  various  nervous  symptoms,  neuras- 
thenia, etc.,  all  of  which  may,  perhaps,  be  regarded  as  of  reflex 
origin ;  but  when  we  see  in  such  people  a  yellow  or  yellowish-gray 
complexion  which,  after  a  good  purge,  resumes  its  clear  condition, 
clinically,  we  regard  it  as  auto-intoxication. 

Even  if,  as  already  mentioned,  most  of  the  elements  of 
albuminous  catabolism  are  not  toxic  if  injected  into  animals,  still, 
occasionally,  toxic  products  can  be  formed,  such  as  cholin  and 
neurin,  which  come  from  the  former.  These  elements  arise 
from  decomposition  of  the  lecithin,  which,  of  our  various  food- 
stuffs, is  contained  in  the  greatest  quantity  in  eggs;  and  these 
substances  can  provoke  serious  nervous  symptoms.  In  such 
cases  there  is,  of  course,  a  stagnation  of  long  duration  of  the 
bowels,  but  such  a  condition  as  the  latter  can  arise  without  a 
stricture  or  obstruction,  although  these  are  the  most  frequent 
causes.     Another  toxic  product  is  the  pepto-toxin  of  Brieger. 

Stagnation  takes  place  in  sluggish  bowels.  As  a  general 
rule,  faecal  movement  is  caused  by  peristalsis  of  the  intestines, 
which  consists  of  circular  contractions  of  the  bowel  by  which  the 
contents  are  propelled  toward  the  end  of  the  same ;  besides  these 
movements  there  are  also  pendular  or  vermicular  contractions  of 
certain  parts  of  the  intestines ;  all  these  movements  also  assist  the 


1  Ewald:  "Die  Autointoxication,"  Beri,  klin,  Wochenschr.,  No.  7-8.  1900. 


Elimination  of  Toxic  Products  'Through  Intestines.       173 

admixture  of  the  chyme  with  the  juices  of  the  intestines.  All  these 
contractions  are  caused  by  impulses  from  the  nerves  which  lie  in 
the  walls  of  the  intestines,  the  plexus  myentericus ;  they  can  also 
be  provoked  by  impulses  coming  from  the  central  nervous  system. 

The  nerve  ganglia  that  lie  in  the  walls  of  the  intestines  can 
be  influenced  mechanically  by  the  contents  of  the  intestines,  when 
such  are  bulky,  and  also  when  they  are  fermenting ;  therefore,  the 
bacteria,  by  promoting  fermentation,  also  aid  in  peristalsis.  The 
bulky  condition  of  the  bowel  contents  can  be  best  induced  by  food 
of  the  vegetable  kingdom  through  its  cellulose  contents,  of  which 
tissue  the  cells  of  plants  or  fruits  are  largely  formed.  When 
these  irritating  agents  act  on  the  nerve  filaments  in  the  intestines, 
the  bowel  will  contract  and  expel  its  contents. 

But  when  food  contains  no  irritating  substances  and  is  easily 
assimilated  without  forming  residues,  or  when  the  innervation 
by  the  vagus  is  sluggish  and  the  peristaltic  movements  are  slow, 
the  contents  of  the  intestines  can  remain  longer,  especially  in  the 
haustra  of  the  intestines.  It  may  be  that  the  bowels  move  every 
day,  but  that  does  not  prove  that  everything  in  the  intestines  has 
been  expelled  therefrom,  for  some  amount  of  faeces  can  yet  re- 
main in  the  haustra  of  the  intestine  even  for  many  days ;  so  that 
in  such  cases  there  is  still  a  constipation  of  one  part  of  the  bowels. 
We  have  observed,  personally,  and  on  patients,  that,  after 
a  good  opening  of  the  bowels,  when  a  purge  is  given — for  in- 
stance, directly  after  a  meal — a  short  time  afterward  there  has 
been  another  copious  discharge  that  had  evidently  remained 
behind.  Thus,  no  doubt  a  retention  of  faeces,  and  sometimes  a 
condition  analagous  to  auto-intoxication,  can  be  caused  in  people 
who  have  the  bowels  opened  every  day,  although  not  to  the 
extent  of  those  having  obstruction  or  habitual  constipation. 

To  avoid  such  a  condition  a  good  purge  should  be  taken 
at  regular  intervals,  say,  once  a  week,  even  by  persons  who  have 
a  movement  daily,  in  order  to  eliminate  matter  which  may  have 
remained.  It  will  not  be  necessary,  naturally,  to  use  a  too 
powerful  purgative,  but  one  adapted  to  the  necessity  of  the  case ; 


174  Old  Age  Deferred. 


taking,  as  a  rule,  such  a  purge  as  will  act  a  little  better  than  the 
ordinary  bowel  movement,  and  graduated  according  to  the 
strength  of  the  person  so  using  it. 

Before  closing  this  chapter  we  must  also  briefly  insist  upon 
the  importance  of  the  fact,  that  the  secretions  of  the  intestine 
and  of  its  glandular  annexes  have  also  an  anti-bacterial  and 
anti-toxic  action.  Very  important  is  the  role  of  the  bile  for  the 
disinfection  of  the  intestine,  as  it  contains  two  acids,  the  glyco- 
cholic  and  taurocholic,  which  possess  highly  anti-fermentative 
properties.  As  already  mentioned,  the  bile  also  assists  in  the 
assimilation  of  fat,  and  also  exercises  a  stimulating  action  on  the 
peristalsis  of  the  intestines. 


CHAPTER  XVIII. 

On  the  Prevention  and  Treatment  of  Habitual 
Constipation. 

We  all  know  from  physiology  that  the  expulsion  of  foecal 
matter  from  the  intestines  takes  place  in  such  a  manner  that  the 
contents  therein  act  as  a  kind  of  extraneous  body  with  stimu- 
lating action  upon  the  walls  of  the  intestines  and  the  plexus 
myentericus  contained  in  the  same.  Consequently  there  follows 
a  contraction  of  the  walls  of  the  intestines,  and  their  contents 
are  expelled.  All  nerves,  the  plexus  myentericus  included,  are 
under  the  control  of  the  central  nervous  system,  which  creates 
motor  impulses  through  the  medium  of  the  pneumogastric 
(vagus),  or  may  cause  a  check  to  the  peristaltic  movements 
through  the  intervention  of  the  splanchnic  nerves. 

Thus,  as  we  see,  different  agencies  influencing  the  central 
nervous  system,  like  strong  emotions,  shock,  etc.,  may  cause  an 
irritation  of  the  pneumogastric,  the  motor  nerve  of  the  intes- 
tines, and  thus  occasion  a  movement  of  the  bowels.  Different 
toxic  products  may  act  also  upon  the  pneumogastric;  strong 
motor  action  of  the  intestine  with  diarrhoea  may  also  be  caused 
by  the  abundant  secretion  of  the  thyroid  gland,  as  in  Graves's 
disease,  where  an  excess  of  toxic  matters  of  the  thyroid  gland 
are  secreted. 

In  the  same  way  we  can  also  produce  diarrhoea  if  we  give 
thyroid  extracts  in  too  abundant  quantity;  but  giving  the  same 
in  more  moderate  doses  will  effect  an  improvement  in  the 
peristaltic  movements. 

That  the  thyroid  gland  has  a  controlling  influence  on  the 
innervation  of  the  intestine  is  evident  from  the  fact  that,  when 
the  thyroid  is  degenerated,  the  bowels  are  very  sluggish.    Under 

(175) 


176  Old  Age  Deferred. 


such  conditions  we  often  find  very  stubborn  constipation ;  but 
when  we  administer  to  such  persons  thyroid  extracts  for  a  given 
time,  we  note  a  considerable  improvement  of  the  bowels,  which 
can  even  go  to  the  extent,  if  too  excessive  doses  be  given,  of 
causing  diarrhoea  as  already  mentioned. 

In  addition  to  the  thyroid  gland,  there  are  other  ductless 
glands  which  seem  to  influence  the  peristaltic  movements  by 
acting  on  the  splanchnic  nerves,  and  these  are  the  sexual  glands. 
In  women  they  are  frequently  altered.  Dysmenorrhcea,  amen- 
orrhea, and  other  troubles  are  frequent,  and  constipation  is  a 
typical  symptom  of  such  conditions.  This  may  also  serve  to 
explain  why  women  are  more  often  constipated  than  men. 

But  the  alteration  of  the  sexual  glands  can  also  cause  con- 
stipation in  men,  if  we  may  draw  the  inference  from  the  great 
frequency  of  constipation  in  diseases  of  the  prostate  gland,  which 
to  some  extent  may  be  in  relation  with  the  subject  with  which 
we  are  now  dealing. 

In  order  to  avoid  constipation  we  must  therefore  observe  a 
careful  hygiene  of  the  thyroid,  and  also  of  the  sexual  glands,  fol- 
lowing the  advice  we  offer  in  special  Chapters  XVIII  and 
XLVIII. 

Besides  constipation,  as  above,  from  the  central  nervous 
system,  the  same  may  be  caused  through  the  lack  of  a  stimulation 
which  may  come  from  the  intestinal  contents.  As  we  have 
already  seen,  the  peristaltic  movements  of  the  intestine  and  the 
expulsion  of  faecal  matter  take  place  through  the  stimulation  of 
the  nerves  in  the  intestinal  walls  by  the  intestinal  contents,  which 
act  either  mechanically  or  by  the  irritation  which  their  fermenta- 
tion causes. 

To  prevent  constipation  we  must  take  such  nourishment  as 
will  act  in  a  stimulating  way,  either  mechanically,  owing  to  its 
bulk,  or  by  the  fermentation  it  causes.  In  order  to  have  good 
bowel  movements  we  must  create  them,  and  this  is  best  done,  not 
by  a  diet  of  meat  and  finely  ground  cereals,  which  are  absorbed 
with  scarcely  any  residue  to  effect  the  purpose,  but  by  one  of 


Habitual  Constipation.  V 


vegetables  and  fruit,  which  contain  cellulose  in  the  largest  quan- 
tity, this  substance  forming  the  framework  of  the  structure  in 
which  the  cells  are  imbedded ;  it  constitutes  the  wall  of  the  cells. 
This  cellulose  provides  us  with  the  best  residue  from  food,  which, 
if  present  in  large  quantities,  will  exercise  a  mechanically  stim- 
ulating action  on  the  intestinal  walls. 

Vegetables  are  thus  a  valuable  aid  in  the  prevention  of  con- 
stipation, and  of  these  the  following  are  the  best :  spinach, 
carrots,  green  beans,  and  boiled  lettuce,  taking  into  consideration 
their  action  as  laxative  food.  Cabbage  also  acts  well  as  a  bulky 
food. 

Graham  bread  and  brown  bread  in  general,  and  in  particular 
a  special  kind,  called  "cellulose"  bread,  are  also  very  good  agents 
with  which  to  prevent  and  to  treat  habitual  constipation.  Some 
breads,  as  various  kinds  made  from  bran,  are  so  coarse  that,  to  a 
certain  extent,  they  may  be  considered  as  setting  up  a  kind  of 
internal  massage  of  the  intestines. 

Not  only  vegetables,  but  fruits,  by  reason  of  the  fruit  sugar 
and  acids  they  contain,  may  also  prove  laxative  if  taken  in  given 
quantities.  Fruits  may  be  taken  stewed,  as  a  compote,  or  baked, 
as  for  instance,  apples;  they  may  also  be  taken  an  naturel  if 
the  condition  of  the  stomach  permits.  Of  compotes  the  most  laxa- 
tive are  plums,  prunelles  (sour  figs),  and  apples;  also  pineapples, 
cherries,  and  various  berries,  all  of  which  may  also  be  partaken 
of  in  the  form  of  a  mush  or  puree,  to  great  advantage;  also 
fruit  juices  and  fruit  wines,  if  free  from  alcohol. 

Of  fresh  fruits,  grapes  and,  according  to  our  observation, 

pineapples  also  undoubtedly  have  the  best  laxative  quality,  as 

also  have  green  figs,  which  can  be  taken  regularly  as  a  preventive 

against  constipation.     Figs  when  dried,  especially  the  so-called 

Olympia  figs  from  Smyrna,  or  the  California  variety,  are  also 

most  beneficial,  their  laxative  properties  to  a  certain  extent  being 

probably  due  to  the  seeds  which  they  contain,  which  serve  as  a 

means  for  intestinal  massage. 

Orange  and  grape-fruit,  taken  on  an  empty  stomach  in  the 

12 


178  Old  Age  Deferred. 


morning,  may  also  have  a  laxative  effect,  due  probably  to  the 
quantity  of  fruit  acids  they  contain. 

We  sometimes  hear  patients  complain  of  constipation  after 
partaking  of  milk.  According  to  our  experience,  this  is  more 
often  the  case  when  boiled  milk,  heated  above  6o°  C,  is  taken. 
On  the  other  hand,  we  believe  that  when  uncooked  milk  is  taken 
it  may  act  as  a  laxative  in  many  persons,  due  to  the  action  of 
milk-sugar  and  acid.  Acidulated  milk  may  have  this  property 
in  a  greater  degree,  as  also  may  buttermilk,  and  especially  whey ; 
all  of  these  are,  on  the  whole,  good  laxatives. 

The  diet  of  those  suffering  from  habitual  constipation 
should  be  as  follows:  In  the  morning,  on  rising,  take  a  glass 
of  cold  water  and  an  orange.  For  breakfast,  one  or  two  oranges 
or  several  slices  of  fresh  pineapple,  or,  in  countries  where  one  is 
so  fortunate  as  to  obtain  such  delicious  and  wholesome  fruit,  a 
grape-fruit;  after  that  one  or  two  soft  boiled  eggs,  cereals, 
Graham  or  brown  bread,  or  one  of  the  kinds  of  coarse  breads  rich 
in  cellulose,  and  fresh  butter  thickly  spread  on  the  bread  (if  the 
stomach  is  good).  Then  follow  with  orange  marmalade  or 
puree  of  prunes,  ending  with  some  grapes.  Honey  (another 
excellent  laxative)  may  also  be  added.  Two  glasses  of  milk  or 
more,  for  those  who  can  stand  it ;  in  fact,  as  much  as  they  desire. 
For  dinner,  the  following  is  recommended :  Roast  or  boiled 
meat,  two  sorts  of  green  vegetables  (by  preference  spinach), 
French  beans,  carrots,  boiled  lettuce,  one  course  of  stewed 
compote  of  fruit,  and  finish  with  dessert  of  grapes,  figs  (dried  or 
green),  or  preserved  plums  (California  or  Bordeaux).  For 
drink,  mineral  waters,  such  as  the  various  light  American  kind, 
either  mixed  with  wine  or  alone.  Alkaline  waters,  such  as 
Biliner,  Vichy,  etc.,  if  taken  very  cold,  may  also  contribute  to  the 
laxative  action.  For  supper,  something  akin  to  breakfast.  As 
we  shall  point  out  in  the  chapter  on  the  hygiene  of  food,  we 
recommend  meat  only  once  a  day. 

We  are  confident,  from  experience  gained  with  our  own 
patients,  that  people  who  follow  such  a  regimen  will  have  an  easy 


Habitual  Constipation.  179 

bowel  movement  daily,  and  will  thus  avoid  those  dangers  which 
are  connected  with  the  habitual  use  of  laxative  drugs. 

For  those  who,  in  spite  of  such  a  course  of  diet,  have  slug- 
gish bowels,  we  recommend  massage  and  electricity,  and  also  cer- 
tain hydrotherapeutic  procedures.  The  method  of  carrying  out 
such  must  be  obtained  from  the  special  hand-books  written  for 
that  purpose;  but  we  would  merely  mention  here  that  massage 
should  preferably  be  performed  by  one  belonging  to  the  medical 
profession,  or,  at  any  rate,  by  one  trained  in  the  Swedish  system. 

Electricity  may  be  applied  by  either  galvanic  or  faradic 
current,  both  of  which  give  excellent  results. 

Hydrotherapeutics  must  not  be  overdone  or  harm  may  result. 
We  find  that  a  compress  of  lukewarm  water  (Pressnitz  compress) 
worn  round  the  abdomen  and  back  through  the  night,  produces 
good  results  in  many  cases,  if  the  diet  is,  at  the  same  time, 
appropriate. 

For  those  who  only  suffer  occasionally  from  constipation, 
as,  for  instance,  after  a  railway  journey,  it  is  an  easy  and  always 
efficacious  method  (if  there  is  no  inveterate  constipation)  to 
take  a  suppository  of  glycerine  and  introduce  it  into  the  rectum. 
After  only  ten  to  fifteen  minutes  interval  there  may  be  a  copious 
evacuation. 

In  persons  where  the  dietetic  and  above-mentioned  mechan- 
ical remedies  have  not  proved  effective,  irrigation  of  the  rectum 
and  intestines  should  be  employed.  We  would  not,  however, 
advise  the  constant  use  of  this  method,  as  torpidity  of  the  in- 
testine might  result  if  practiced  daily  (see  chapter  on  the  hygiene 
of  the  intestines). 

In  cases  where  there  is  a  more  serious  degree  of  constipation 
a  little  soap,  or  olive  or  castor  oil,  should  be  added  to  the  water, 
together  with  a  little  soda  to  assist  the  formation  of  an  emulsion. 

Enemata  possess  the  advantage  of  having  nothing  to  do 
with  the  stomach,  and  thus  this  important  organ  can  be  spared 
much  irritation  which,  unfortunately,  cannot  be  avoided  when 
other  purging  remedies,  such  as  drugs,  are  given,  all  of  which 


180  Old  Age  Deferred. 


must  pass  through  the  stomach  when  taken  by  the  mouth.  If  we 
find  it  necessary  to  resort  to  laxative  drugs  by  the  mouth  we 
must  first  try  such  drugs  as  are  least  irritating  to  the  stomach 
and  intestines,  and  foremost  among  these  is  rhubarb,  which  can 
be  taken  in  the  form  of  a  compote  as  well  as  a  drug.  To  this  it  is 
well  to  add  magnesia  and  bicarbonate  of  soda.  We  should,  if 
possible,  administer  only  the  mildest  purgatives,  and,  therefore, 
if  rhubarb  is  not  effective,  we  may  give  cascara  sagrada,  or  the 
pulp  of  tamarind,  which  is,  moreover,  pleasant  to  take;  but  the 
action  is  not  so  pronounced  as  in  the  case  of  cascara  sagrada 
(rhamnus  purshiana). 

Before  resorting  to  drugs,  however,  we  think  it  would  be 
better  to  try  the  natural  mineral  waters,  and  only  when  these  fail 
should  we  fall  back  on  drugs. 

There  are  two  kinds  of  mineral  waters,  each  varying  in  its 
action:  I.  The  milder  acting  water,  of  a  laxative  nature.  2. 
Stronger  water,  with  drastic  action.  Of  the  former  we  will  men- 
tion those  which  are  employed  for  several  weeks  continuously 
for  a  regular  cure :  Germany :  Kissingen ;  Austria :  Carlsbad ; 
Marienbad.  As  the  author  of  this  book  is  himself  a  practicing 
physician  at  one  of  these  springs,  he  thinks  it  more  becoming  to 
pass  over  in  silence  which  of  these  waters  is  preferable.  Each 
of  them,  as  also  many  others  not  mentioned  for  want  of  space, 
have  their  undoubted  merits.  A  teaspoonful  of  Sprudel  salt, 
taken  in  a  glass  of  lukewarm  water  in  the  morning  on  an  empty 
stomach,  will  give  excellent  results ;  but  it  should  not  be  taken 
every  day  for  any  length  of  time,  as  otherwise,  as  with  all  other 
drugs  if  taken  continuously,  it  may  deaden  the  excitability  of  the 
nerves  of  the  intestines,  and  success  depends  upon  keeping  these 
nerves  in  such  a  condition  that  they  may  respond,  upon  a  light 
stimulation,  with  a  contraction  of  the  intestinal  walls  and  expul- 
sion of  the  fsecal  matter. 

Of  the  strong  mineral  waters  with  drastic  action,  there  are 
several  excellent  springs  in  America,  some  of  them  surpassing 
many  of  the  European  mineral  waters.     In  Europe  there  are  in 


Habitual  Constipation.  181 

Hungary :  Hunyacli-Janos,  Ferencz-Jozsefforras,  etc. ;  Spain  : 
Rubinat,  Villacabra-Loeches,  etc. ;  and  elsewhere  a  number  of 
such  springs.  As  all  are  natural  remedies  they  should  be  used 
in  preference  to  drugs  when  the  intestine  does  not  respond  to 
mild  laxatives  and  a  strong  whip  is  needed.  In  my  opinion  they 
are  less  fitted  for  every  day  treatment,  though  well  adapted  for 
a  thorough  cleaning  out  of  the  intestine  to  get  rid  of  stagnant 
matter  (see  Chapter  XIX). 

These  strong,  drastic,  natural  waters  act  by  causing  a  transu- 
dation into  the  intestine,  creating  a  condition  somewhat  similar 
to  a  catarrh,  but  in  a  more  benign  way. 

Briefly,  the  best  and  most  rational  treatment  of  sluggish 
bowels  is  by  stimulating  the  intestine  by  means  of  an  appropriate 
diet  which,  at  the  same  time,  tends  to  ward  off  old  age. 


CHAPTER  XIX. 
Hygiene  of  the  Intestines. 

As  the  means  by  which  we  are  able  to  keep  the  intestines 
in  good  working  order  are  of  the  same  efficacy  also  for  the 
stomach,  all  that  is  necessary  to  mention  in  this  chapter  about 
the  intestines  will  apply  equally  to  the  hygiene  of  the  stomach. 
The  same  applies  also  to  the  pancreas,  so  that  it  is  unnecessary 
to  treat  of  its  hygiene  separately.  It  is  also  our  intention  in  this 
book  to  mention  only  the  hygiene  of  those  organs  which  are 
able  to  rid  the  body  of  toxic  products,  as  it  is  mainly  by  their 
degeneration  that  premature  old  age  is  brought  about. 

There  is  scarcely  a  serious  disorder  of  the  stomach  without 
an  attendant  alteration  of  the  intestinal  functions.  All  the  differ- 
ent agencies  that  are  dangerous  to  the  stomach  will  also  prove 
dangerous  to  the  intestines.  We  have  mentioned  several  of  these 
in  the  chapter  on  food  and  the  hygiene  of  eating,  where  we  have 
pointed  out  that  defective  mastication  is  very  deleterious.  Food 
introduced  into  the  stomach  passes  into  the  intestines,  and  if  it 
reaches  these  insufficiently  masticated  it  will  present  great  diffi- 
culties for  the  penetration  of  the  intestinal  ferments.  Not  only 
will  it  not  be  well  digested,  but  as  the  different  ferments  cannot 
well  penetrate  these  compact  masses  they  will  putrefy,  thus  con- 
siderably increasing  the  natural  fermentation,  in  consequence  of 
which  a  great  amount  of  toxic  products  and  a  considerable  irri- 
tation of  the  intestinal  mucous  membrane  will  result,  which  may 
subsequently  cause  disease.  By  thoroughly  masticating  every- 
thing we  eat,  we  are  not  only  safeguarding  the  condition  of  the 
stomach,  but  also  that  of  the  intestine. 

The  integrity  of  the  functions  of  the  intestines  is  of  supreme 
importance,  for  it  is  here  that  absorption  and  assimilation  of  most 
(182) 


Hygiene  of  the  Intestines.  183 

of  our  food  occurs.  If  our  intestines  are  not  in  perfect  order  we 
shall  soon  waste  and  dwindle  away,  even  within  a  short  period, 
and  sometimes  very  rapidly.  Thus  if  we  wish  to  retain  our 
strength  we  must  treat  the  intestine  with  the  greatest  care.  This 
is  especially  the  case  in  old  age,  for  then  an  atrophy  of  the 
glandular  mechanism  of  the  digestive  tract,  stomach,  and  intes- 
tines, takes  place.  Thus  old  people  will  not  be  able  to  assimilate 
nourishment  to  the  same  extent  as  younger  ones ;  they  will  lose  a 
portion  of  its  nutritive  value,  and  it  will  become  more  and  more 
difficult  for  them  to  completely  digest  their  food.  To  such  peo- 
ple, therefore,  it  will  be  necessary  to  give  food  in  a  form  that  is 
easily  absorbed,  preferably  in  liquid  form;  it  would  also  be 
desirable  to  give  them  their  albuminous  food  in  a  predigested  and 
soluble  form.  In  Germany,  especially,  are  used  a  considerable 
number  of  so-called  "Nahrpraparate,"  a  nutritive  preparation 
which  contains  albumin  in  the  form  of  albumose,  which  naturally 
can  be  assimilated  easier ;  there  are  also  carbohydrate  preparations 
in  which  the  starch  is  transformed  into  dextrin  or  maltose.  There 
is  a  legion  of  such  preparations,  but  it  would  lead  us  too  far  to 
enlarge  on  them  by  a  longer  description.  They  are  produced 
from  proteids,  many  of  them  from  fish,  or  from  blood,  or  from 
eggs;  also  from  milk;  while  others  consist  of  finely  ground 
preparations  of  wheat,  oatmeal,  barley,  rice,  arrowroot,  sago, 
tapioca,  buckwheat,  Indian  corn,  etc.  As  aged  persons  have 
greater  difficulty  in  assimilating  in  their  intestines  and  stomach 
food  in  its  natural  state,  the  use  of  the  best  of  these  predigested 
preparations  would  certainly  be  advisable  in  order  to  insure  a 
healthy  condition  of  the  intestines  and  a  prolongation  of  life. 
The  last  mentioned  carbohydrate  preparations  possess  also  the 
great  advantage  of  preventing  an  excessive  putrefaction  of  the 
intestinal  contents  with  its  harmful  consequences,  which  tendency 
is  always  greater  with  albuminous  food,  starchy  foods  in  large 
quantity  tending,  as  already  stated,  to  produce  acid  fermenta- 
tion in  the  intestines  by  which  many  products  of  albuminous 
digestion  can  be  destroyed.    Against  these  poisons  formed  in  the 


184  Old  Age  Deferred. 


intestinal  tract  we  possess  a  natural  defense  in  certain  ductless 
glands,  the  thyroid  and  liver,  which  are  degenerated  in  old 
people ;  therefore  carbohydrate  is  the  best  for  them. 

The  prevention  of  intestinal  putrefaction  is,  however, 
equally  important  in  younger  people.  As  Combe  proves,  we 
can  avoid  this  by  the  use  of  certain  kinds  of  food,  especially  car- 
bohydrates and  fruit,  and  by  other  substances  producing  lactic 
acid,  which  is,  indeed,  the  best  disinfectant  for  the  intestines. 
The  great  benefit  of  various  kinds  of  sour  milk  generally  has  been 
pointed  out  by  Metschnikoff  and  his  disciples.  Among  the  causes 
of  old  age  this  savant  attributes  an  important  role  to  the  processes 
of  putrefaction  in  the  intestines,  and  to  avoid  this  he  recommends 
the  use  of  a  certain  kind  of  sour  milk  produced  by  fermentation 
by  a  number  of  microbes,  including  the  Bulgarian  Baccillus  may  a. 

That  certain  kinds  of  food  exercise  poisonous  effects  when 
introduced  into  the  intestines  is  a  matter  of  common  observation. 
Thus,  in  not  a  few  cases,  fever,  accompanied  by  cutaneous  erup- 
tion, may  be  witnessed  after  partaking  of  strawberries  or  oysters, 
and  especially  after  eating  meats  (notably  sausages)  which  are 
in  a  state  of  decomposition.  Severe  cases  of  poisoning,  even  re- 
sulting in  death,  have  occurred ;  and  in  Germany  there  have  been, 
from  time  to  time,  regular  epidemics  after  partaking  of  sausages 
in  the  above  condition. 

Of  course  everyone  partaking  of  such  poisonous  food  will  not 
become  poisoned  as  this  is  prevented  by  the  action  of  such  glands 
as  the  thyroid  and  liver,  whose  function  it  is  to  preserve  us  from 
such  effects.  People  in  possession  of  healthy  sensory  organs, — • 
eyes,  nose,  and  tongue,- — will  be  enabled  to  tell  whether  meat 
is  in  a  fit  condition  to  be  eaten  or  not ;  but  frequently  we  cannot 
discover  by  our  senses  a  state  of  decomposition  when  such  is 
not  in  an  advanced  stage,  and  if  such  food  is  taken  regularly 
and  in  large  quantities  the  great  number  of  microbes  we  thus 
introduce  into  the  intestines  will  poison  us  slowly  but  surely. 

Such  poisonous  microbes  thrive  and  multiply  very  well  in 
the  alkaline  contents  of  the  intestines,  but  the  growth  of  such 


Hygiene  of  the  Intestines.  185 

dangerous  bacteria  can  be  greatly  hindered  by  the  introduction 
therein  of  acid  substances,  especially  lactic  acid.  It  has  been 
observed  by  several  authorities,  such  as  Grundzach,1  Schmitz,2 
and  Singer,3  that  lactic  acid  decreases  intestinal  putrefaction, 
and  also  the  conjugated  ether  sulphates  in  the  urine. 

Professor  Metschnikoff,  of  the  Pasteur  Institute  in  Paris, 
deserves  great  credit  for  having  insisted  on  the  importance  of 
introducing  certain  microbes  into  the  intestines  for  the  purpose 
of  transforming  the  sugar  of  their  carbohydrate  contents  into 
lactic  acid,  and  thus  causing  the  disinfection  of  the  intestines  by 
destroying  the  noxious  germs  and  hindering  their  development. 
For  this  purpose  the  so-called  Bulgarian  bacillus  can  best  be 
employed,  as  it  is  able  to  transform  the  cultures  of  pathologic 
microbes  in  the  intestines  into  a  beneficient  growth  that  is  quite 
harmless. 

This  Bulgarian  bacillus  is  well  known  because  of  its  action  in 
producing  the  sour  milk  "yoghurt"  of  the  Bulgarian  population, 
to  the  use  of  which,  according  to  Metschnikoff,  is  due  the  very 
large  number  of  centenarians  to  be  found  in  that  country. 

The  action  of  the  lactic  bacilli  has  been  proved  by  the  experi- 
ments of  Dr.  Herter,  of  New  York,4  who  discovered  that  by  the 
introduction  of  large  quantities  of  these  bacilli  into  animals  their 
intestinal  putrefaction  was  diminished. 

Dr.  Michel  Cohendy5  has  performed  similar  experiments 
on  himself.  After  taking  for  twenty-five  days  his  usual  diet  and 
subsequently  noting  the  degree  of  his  intestinal  putrefaction,  he 
took  pure  cultures  of  a  lactic  bacillus,  extracted  from  "yoghurt." 
For  more  than  two  months  he  continued  to  take  large  quantities 
of  these  bacilli  (280  to  350  grammes  a  day).  Not  only  dur- 
ing the  course  of  the  experiment  did  the  urine  exhibit  evidences 


1  Grundzach :     Zeitschrift  fiir  klin.  Medicine,  p.  79,  1893. 

2  Schmitz:     Zeitschrift  fiir  Physiologische  Chemie,  vol.  xix,  1897. 

3  Singer:  Therapeutische  Monatshafte,  p.  441,  1901. 

4  Herter:     Brit.  Med.  Jour.,  p.  1898,  Dec.  25,  1897. 

5  Cohendy:     C.  It.  de  la  Socigtg  de  Biologie,  Mars  17,  1906. 


186  Old  Age  Deferred. 


of  a  diminution  of  intestinal  putrefaction,  but  this  continued 
for  seven  weeks  afterward,  and  he  arrived  at  the  conclusion  that 
the  lactic  acid  fermentation  due  to  this  bacillus  was  able  to  hinder 
the  putrefying  action  of  the  microbes  developed  from  the  meat 
he  had  taken  during  his  experiments.  He,  therefore,  comes  to 
the  conclusion  that  it  is  unnecessary  to  discontinue  meat  food 
for  the  suppression  of  intestinal  intoxication  if  lactic  bacilli  be 
taken  therewith. 

Dr.  Pochon,  assistant  to  Professor  Combe,  of  Lausanne, 
continued  upon  himself  the  experiments  of  Dr.  Cohendy.  For 
several  weeks  he  took  sour  milk  (lait  caille)  which  was  prepared 
from  cultures  of  pure  lactic  microbes,  and  he  found  positive  proofs 
of  the  checking  of  intestinal  putrefaction  thereby.6  In  those,  there- 
fore, who  are  able  to  procure  and  use  a  pure  preparation  of  lactic 
bacilli,  intestinal  putrefaction  will  be  greatly  diminished.  But 
even  when  we  cannot  obtain  these  preparations  we  can  follow  a 
diet  that  will  tend  to  develop  lactic  acid  fermentation.  This  can 
be  brought  about  by  taking  carbohydrates  in  large  quantities,  espe- 
cially those  which  are  very  rich  in  sugar,  at  the  same  time  taking 
milk,  particularly  sour  milk. 

It  is  an  absolute  fact  that  in  those  who  are  addicted  to  a 
diet  of  carbohydrates,  intestinal  putrefaction  is  diminished,  owing 
to  the  formation  of  lactic  acid  from  the  fermentation  of  the  milk- 
sugar  which  is  contained  in  such  carbohydrates. 

Intestinal  putrefaction  is  enhanced  by  the  alkaline  contents 
of  the  intestines ;  it  can,  therefore,  be  checked  by  various  agencies 
that  diminish  the  alkalinity  of  the  intestine,  such,  for  instance, 
as  by  lactic  acid,  just  referred  to.  Fatty  and  acetic  acids  also 
effect  this ;  likewise  fatty  food,  which  promotes  the  formation  of 
fatty  acids.  Cheese  may  produce  fatty. and  also  lactic  acids; 
wherefore  it  is  of  value  to  combat  putrefaction  in  the  intestines. 
Of  the  further  benefits  of  cheese  as  an  article  of  food,  we  make 
mention  in  the  chapter  on  the  hygiene  of  food ;  we  also  state  there 


6  Combe:     "L'Auto-intoxication  intestinale,"  Paris,  1906. 


Hygiene  of  the  Intestines.  187 

that  it  is  unsuitable  in  those  cases  in  which  the  intestines  are  not 
in  thorough  order. 

Great  care  should  be  exercised  in  the  quality  of  the  food. 
The  freshness  of  various  foods  is  of  the  greatest  importance  to  the 
intestines,  since  the  main  function  of  the  stomach  is  principally  a 
mechanical  one,  serving  to  reduce  the  food  into  a  convenient  form 
and  carry  it  to  the  intestines,  ready  to  be  there  prepared,  through 
the  influence  of  the  intestinal  juices,  into  a  condition  fit  for  absorp- 
tion and  assimilation.  During  this  process  the  food  is  being 
reduced  to  its  simpler  elements,  and  the  more  noxious  substances 
are  being  freed  to  commence  their  baneful  activity.  These  sub- 
stances first  of  all  create  an  inflamed  condition  of  the  intestines; 
then,  being  absorbed  into  the  blood,  they  cause  a  general  intoxica- 
tion. Fortunately  they  are  not  frequently  absorbed,  and  thus  their 
injurious  effect  is  limited  to  the  intestine.  Among  other  such  in- 
jurious foods  we  may  mention  fish  and  oysters,  sausages  and  meats 
that  are  in  a  state  of  decomposition ;  fruit  that  is  unripe  or  unsound ; 
and  canned  food  in  which  certain  drugs  are  used  as  preservatives, 
such  being  poisonous  in  varying  degree,  examples  being  salicylic 
boracic,  and  sulphuric  acids,  etc.,  and  at  times  even  the  terrible 
poison,  verdigris.  Fresh  food  should  always  be  preferred  to 
canned  food,  or  to  food  preserved  in  other  forms  for  too  long  a 
period  (see  also  chapter  on  the  hygiene  of  food). 

The  stomach,  and  intestines  also,  can  frequently  suffer 
damage  from  ice  cold  drinks,  especially  if  taken  habitually  and  in 
large  quantities.  As  already  mentioned  in  the  chapter  on  the 
hygiene  of  the  kidneys,  we  should  never  forget  that  every  sort  of 
food  or  drink  must  pass  a  series  of  delicate  epithelia  of  our  noblest 
organs,  which  can  be  injured  by  sharp  and  poisonous  substances 
with  which  they  come  in  contact. 

More  injurious  is  the  action  of  various  kinds  of  noxious 
food,  especially  if  putrid,  which  remain  for  a  long  time  in  the 
intestines,  thus  creating  a  chemical  laboratory  constantly  prepar- 
ing poisons.  Even  the  residue  of  less  harmful  foods,  espe- 
cially albuminous,  even  if  of  good  quality,  when  taken  into  the 


188  Old  Age  Deferred. 


body,  can  become  deleterious  if  it  remains  too  long  in  the  intes- 
tines. It  will,  therefore,  be  a  part  of  the  highest  wisdom  to 
exercise  care  in  having  these  highly  important  organs,  on  which 
all  our  nutrition  depends,  in  thoroughly  good  working  order  by 
keeping  them  clean  and  by  removing  stagnant  material.  We  have 
already  designated  the  best  way  to  effect  this  in  a  previous  chap- 
ter, and  we  desire  here  to  say  a  few  words  on  the  abuse  of,  and 
great  dangers  arising  from,  remedies  conscantly  prescribed  for 
constipation. 

We  have  insisted  in  the  foregoing  pages  on  the  necessity  of  a 
daily  bowel  movement,  and  have  stated  that  appropriate  food  is 
the  best  way  to  attain  this.  Food  that  leaves  no  residue,  like 
meat  or  finely  ground  cereals,  is  incapable  of  producing  a  stool. 
Hence,  as  Schmidt  has  pointed  out,  constipation  is  often  caused 
by  the  food  being  too  completely  absorbed.  Strassberger,  by 
analyzing  and  counting  the  number  of  bacteria  in  the  stools, 
found  that  certain  cases  of  constipation  were  caused  by  a  dimin- 
ished fermentation  in  the  bowels.  Lohrisch  has  found  that  in 
persons  whose  intestines  possess  a  marked  power  for  absorption 
there  does  not  remain  in  them  a  residue  sufficient  for  the  action 
of  the  bacteria,  and  thus  there  will  not  be  a  sufficient  fermenta- 
tion to  act  as  a  stimulant  to  the  intestinal  walls  to  cause  them  to 
expel  their  contents.  Uncooked  cold  milk  (especially  but- 
termilk, whey,  sour  milk,  "yoghurt,"  kefir,  etc.),  and  dishes  con- 
taining vegetables  and  fruit,  grapes,  puree  of  prunes,  marmalade 
of  oranges,  and  brown  bread  ( Graham,  Pumpernikel,  etc. )  should 
produce  a  movement  of  the  bowels  every  day  in  a  normal  man  or 
woman.  There  are,  however,  many  exceptions  to  this,  especially 
in  the  case  of  women,  caused  either  by  previous  errors  in  diet, 
or  by  negligence  in  answering  at  once  the  demands  of  the  bowels 
for  an  immediate  evacuation,  and  also,  very  often,  by  an  abuse 
of  purgatives.  All  this  is,  of  course,  aggravated  in  those  in 
whom  the  innervation  of  the  bowels,  which  is  controlled  by  the 
splanchnic  nerves  and  the  vagus,  is  altered  by  the  degenerative 


Hygiene  of  the  Intestines.  189 

condition  of  certain  glands  which  influence  these  nerves :  the 
sexual  organs  and  the  thyroid. 

These  alterations  are  far  more  common  in  women,  as  fre- 
quently mentioned  before,  as  their  sexual  glands  and  thyroid  are 
so  often  irritated  by  physiological  and  pathological  processes 
peculiar  to  her  sex,  and  which  so  frequently  recur  during  the  life 
of  a  woman.  It  is  a  fact  that  most  of  the  diseases  of  the  female 
sexual  mechanism  are  followed  by  alterations  in  the  intestines, 
due,  in  part,  to  their  close  proximity  to  the  pelvic  organs,  but,  in 
a  greater  degree,  to  the  intimate  relation  of  these  regions  to  the 
nerves  that  control  the  intestines.  The  same  is  true  to  a  lesser 
degree  in  man,  so  that  after  troubles  with  the  prostate,  or  after 
chronic  gonorrhoea,  a  regulation  of  the  bowels  is  an  important 
matter,  constipation  being  usually  very  obstinate  in  such  cases. 

In  addition  to  this  'sluggishness  of  the  bowels  in  females, 
owing  to  anatomical  and  physiological  causes,  there  may  be  asso- 
ciated faults  arising  from  a  bad  habit.  Instead  of  paying  special 
regard  to  the  innate  tendency  toward  constipation  and  endeavor- 
ing to  have  a  movement  every  day,  many  women,  especially 
young  girls,  neglect  this  by  even  resisting  the  demand  of  the 
intestine  to  be  evacuated,  and  deferring  this  most  important 
function  to  the  following  day,  or  even  later.  Such  a  course 
necessarily  lowers  the  vitality  of  the  intestinal  nerves  and  mus- 
cles. As  soon  as  such  a  nervous  impulse  is  felt,  we  must  promptly 
act  on  it;  should  we  not  do  so  a  greater  nervous  and  muscular 
effort  must  followr,  and,  if  even  then  we  neglect  to  obey  the  call 
of  Nature,  after  several  such  useless  efforts  the  nerves  and  mus- 
cles of  the  intestines  will  relax,  particularly  if  such  a  foolish 
practice  be  often  repeated,  for  it  is  quite  natural  that  such  an 
intestine  will  not  respond  to  the  stimulation  by  the  pressure  of  its 
contents  upon  the  nerves,  and  its  muscles  will  not  contract  to 
expel  the  fsecal  contents,  as  in  normal  people. 

Unless,  therefore,  from  force  of  circumstances,  it  is  impos- 
sible, we  must  at  once  respond  to  the  first  admonition  of  the  in- 
testines, and  not  exhaust  the  vitality  of  its  nerves  and  muscles 


190  Old  Age  Deferred. 


by  exposing  them  to  unnecessary  efforts  at  our  own  expense. 
Some  people  are  so  impressed  with  the  importance  of  immedi- 
ately answering  such  a  call  that  they  will  forego  the  most  urgent 
business  on  that  account.  I  know  an  authentic  case  of  a  member 
in  the  profession — a  great  surgeon — who,  a  few  years  ago,  was 
urgently  summoned  to  a  member  of  the  highest  nobility  who 
had  met  with  a  hunting  accident.  Unfortunately  for  the  patient 
the  call  came  at  just  such  a  moment  as  we  have  been  speaking 
of ;  true  to  his  principles,  he  did  not  arrive  immediately,  but  only 
after  having  fulfilled  the  execution  of  this  important  part  of  the 
hygiene  of  his  intestines,  and  the  patient  lost  his  life. 

Happily  such  an  instance  is  of  the  rarest  occurrence  in  our 
profession,  for  we  always  ignore  our  own  chance  for  a  long  life 
in  favor  of  our  patient's,  which  is  fully  proved  by  the  fact  that, 
of  all  professions,  the  physician's  life  is  the  shortest. 

Corsets  as  worn  by  women  contribute  to  develop  in  them 
ptosed  bowels — gastroptosis  and  enteroptosis — which  can  easily 
arise  after  pregnancy;  the  strength  of  the  intestinal  muscles 
becomes  still  more  diminished  and  constipation  is  the  consequence. 

It  is  not  to  be  wondered  at  if  women,  and  men  also,  in  cases 
where  the  diet  alone  does  not  bring  about  an  ordinary  movement, 
should  resort  to  drugs,  several  of  which  we  have  mentioned  pre- 
viously. At  first,  even  the  mildest  drugs  will  act;  but,  un- 
fortunately, after  a  time  the  intestine  becomes  accustomed  to 
them  and  they  cease  to  act.  Stronger  drugs  are  then  resorted  to, 
such  as  often  contain  aloes,  which,  besides  injuring  the  stomach, 
act  in  a  very  irritating  way  on  the  intestines;  these  respond  by 
a  very  strong  action,  causing  copious  stools  accompanied  by  colicky 
pains.  But  it  is  in  the  nature  of  things,  as  we  have  observed 
holds  true  in  any  organ,  that  overstimulation  of  any  function  is 
followed  by  its  exhaustion;  thus  the  nerves  and  muscles  of  the 
intestine  get  over  irritated  and  relax  if  obliged  to  overact.  After 
a  copious  evacuation  caused  by  strong  drugs  we,  therefore,  find  a 
still  more  obstinate  constipation  than  before.  Stronger  and 
stronger  drugs  are  then  used  until  there  is  a  complete  break- 


Hygiene  of  the  Intestines.  191 

down  and  ruin  of  the  intestinal  innervation  and  muscular  action. 
We  must,  therefore,  commence  first  with  a  suitable  diet,  then  use 
mild  drugs  if  necessary,  with  massage  and  electricity,  as  already 
described. 

Intestinal  enemata  are  also  beneficial,  but  if  a  large  amount 
of  liquid  be  used  the  muscular  walls  get  too  greatly  dilated  and 
may  lose  their  elasticity  and  vitality,  particularly  if  strong  drugs 
be  used  in  such  enemas. 

Many  women  suffer  from  habitual  constipation  by  reason 
of  their  drinking  but  little  water,  especially  if  the  food  they  take 
contains  little  fluid ;  the  faecal  masses  become  solid  and  coagu- 
lated, and  thus  their  passage  in  the  intestine  toward  the  anal 
exit  becomes  more  difficult,  whereas  by  a  sufficient  quantity  of 
liquid,  such  as  water,  this  movement  will  be  much  facilitated ;  and 
that  this  is  an  important  consideration  is  quite  evident  in  the  case 
of  women  who  have  a  tendency  to  lethargic  bowels.  Such  a 
thickening  of  the  faecal  masses  occurs  particularly  in  certain 
parts  of  the  intestines,  such  as  the  caecum,  the  ascending  colon, 
and  the  sigmoid  flexure.  In  these  parts  the  faecal  matters 
often  become  detached,  accumulate,  and  easily  get  condensed. 
They  may  remain  there  sometimes  for  longer  periods,  which  can 
easily  be  proved  by  experiments,  giving  bismuth  by  mouth  and 
then  examining  the  abdomen  by  means  of  the  Roentgen  rays. 

It  thus  happens  that  people,  under  the  impression  that  a 
good  daily  stool  has  produced  a  clean  bowel,  still  have  a  residue, 
and  this  can  instantly  be  seen  by  removing  the  same  by  purging 
drugs.  We,  therefore,  recommend  the  weekly  use  of  a  reliable 
purgative,  such  as  bitter  water,  thus  cleaning  the  bowels  of  all 
residue,  which  frequently  remains  in  deep  haustra  of  the  intes- 
tines, as  in  Barlow's  disease. 

The  stagnation  of  faeces  around  the  caecum  may  also  facili- 
tate the  development  of  appendicitis,  this  being  frequently  due  to 
neglect  of  the  hygiene  of  the  intestines.  It  is  also  one  of  the 
commonest  diseases,  as  we  will  show  in  the  succeeding  chapter. 


CHAPTER  XX. 

Hygiene  of  the  Intestines — A  Few  Remarks  on  the 
Cause  and  Prevention  of  Appendicitis. 

Appendicitis,  in  these  days,  is  one  of  the  most  frequent 
causes  of  an  unexpected  death.  As  this  work  is  designed  to  set 
forth  the  means  by  which  we  may  prolong  life,  it  is  desirable  not 
to  miss  the  opportunity  of  offering  a  few  remarks,  in  connection 
with  the  chapters  on  the  preservation  of  the  intestinal  functions, 
upon  the  cause  and  prevention  of  an  intestinal  disease  by  which 
particularly  young  and  promising  lives  are  frequently  cut  off. 

In  the  previous  chapters  we  saw  that  the  caecum  was  one 
of  the  places  of  selection  for  the  stagnation  of  the  faecal  contents 
in  the  intestinal  canal.  As  the  pressure  of  such  faecal  matter  in 
the  caecum  and  colon  is  greatest  toward  the  appendix  the  contents 
may  go  more  easily  into  than  away  from  the  appendix,  and  par- 
ticularly so  when,  from  a  long  rest  in  the  caecum,  they  are  thick- 
ened. The  return  of  faecal  matter  from  the  appendix  is  often 
hindered  by  a  spindle-shaped  thickening  at  the  junction  of  the 
appendix  with  the  caecum,  which  presents  the  appearance  of  a 
narrow  bridge. 

This  thickening  of  the  mouth  of  the  appendix  is  the  conse- 
quence of  the  very  close  contact  of  the  psoas  muscle,  upon  which, 
in  many  people,  the  appendix  lies,  so  to  speak  resting  upon  it. 
This  has  been  shown  by  Offerhaus1  (a  surgeon  in  the  Hague  Hos- 
pital) to  be  the  case  in  62  per  cent,  of  normal  men. 

In  certain  movements,  such  as  running  or  cycling,  the  psoas 
is  continually  pressing  against  the  appendix,  and  it  is  natural 
that  such  continuous  pressure  against  this  organ  will  in  time 
leave  a  permanent  mark,  which  is,  indeed,  seen  in  many  cases  of 

1  Offerhaus :      Proef schrif t,   "Eine  meehanische  oorzaak  voorhet  ontstaan 
van  Appendicitis,"  Leiden,  1901. 

(192) 


Prevention  of  Appendicitis.  193 

appendicitis.  After  a  certain  time  a  circumscribed  segmentation 
will  be  visible  on  the  parts  of  the  appendix  which  are  in  contact 
with  the  psoas,  and  later  this  becomes  so  marked  that  a  circular 
kinking  results,  establishing  the  narrow  bridge  to  which  we  have 
already  referred. 

It  is  logical  that  the  thicker  the  appendix,  the  more  pro- 
nounced will  be  the  marks  produced  by  the  pressure  of  the  psoas. 
The  average  size  of  the  appendix,  even  in  the  adult,  is  that 
of  a  somewhat  slender  worm,  from  which  is  derived  the  name 
"vermiform  appendix."  But  when  there  is  stagnation  of  the 
faecal  contents  in  the  appendix,  and  especially  when  the  thickened 
faecal  matters  are  of  such  hard  consistency  that  a  hard  stony 
concrement,  such  as  the  coprolith  is  formed,  then  the  appendix 
sometimes  assumes  quite  a  comparatively  large  size.  We  saw 
the  case  of  a  girl  of  16,  operated  on  by  Dr.  Offefhaus  at  the 
Hague  (details  of  which  case  were  published  by  him),  in  whom 
the  appendix  was  of  the  size,  in  circumference,  of  a  large  thumb. 

In  such  large  appendices  the  marks  of  the  psoas  will,  of 
course,  be  more  pronounced,  and  frequently  the  narrow  bridge 
referred  to  will  develop.  This  is  caused  by  the  appendix  being 
further  attached  to  the  intestines  where,  owing  to  the  narrow 
connecting  bridge,  it  is  unable  to  evacuate  itself,  and  so  grows 
larger  and  larger,  the  mischief  thus  constantly  increasing. 

It  is  also  evident  that  the  nutrition  of  an  organ  whose  blood- 
supply  is  mechanically  interfered  with,  as  in  the  case  of  the 
appendix  by  its  close  contact  with  the  psoas,  as  described  above, 
must  necessarily  be  a  precarious  one ;  and  it  is  a  pathological  fact 
that  an  organ  which  is  badly  supplied  with  blood  is  also  more 
liable  to  disease,  because  the  insufficient  supply  of  blood 
causes  a  diminution  in  the  number  of  phagocytes  thereby 
weakening  the  defense  of  the  organ  against  infection,  as  ex- 
plained in  Chapters  III  and  X.  Consequently  the  mi- 
crobes easily  prevail,  particularly  in  a  portion  of  the  body 
like  the  intestines,  where  they  normally  exist  in  such  great 
numbers. 

13 


194  Old  Age  Deferred. 


By  the  foregoing  we  have  not  only  shown  the  cause,  but 
also  the  principles  for  a  rational  prevention,  of  appendicitis.  As 
we  have  seen,  the  starting  point  of  all  mischief  is  the  close  prox- 
imity of  the  psoas  to  the  appendix,  and  the  occasional  cause  is 
constipation,  with  stagnation  of  the  fsecal  contents.  The  best 
preventative  against  appendicitis  consists  in  avoiding  both  causes, 
which,  however,  is  only  possible  in  the  latter  case  by  adopting 
all  those  measures  we  have  mentioned  in  the  chapter  on  the 
treatment  of  constipation. 

The  first  cause,  the  close  contact  of  the  psoas  with  the  appen- 
dix, can  certainly  not  be  prevented;  but  what  we  can  do  is  to 
avoid  all  movements  by  which  the  psoas  is  unduly  pressed  against 
the  appendix.  This  can  be  done  by  avoiding  those  exercises  in 
which  the  psoas  is  brought  into  frequent  contraction  and  then 
pressed  forcibly  against  the  appendix:  for  instance,  running, 
cycling,  etc.  The  young  lady,  already  referred  to,  with  the  large 
stone  in  the  appendix,  indulged  freely  in  such  sports.  The  habit 
of  sitting  with  one  leg  crossed  over  the  other  should  also  be 
avoided. 

We  must  now,  however,  determine  who  those  persons  are 
in  whom  such  a  condition  exists.  They  are  those  who  frequently 
complain  of  pains  in  the  appendicular  region,  usually  after  quick 
walking  or  running,  and  especially  after  cycling,  and  at  times 
even  without  these ;  but  in  this  latter  class  the  plain  is  milder.  In 
order  to  make  an  exact  diagnosis  whether  such  pains  are  caused 
by  pressure  of  the  psoas  upon  the  appendix,  we  must  tell  the 
patient  to  lift  the  right  leg  high  and  we  then  press  with  the  right 
hand  against  the  thigh.  If  there  is  a  latent  form  of  appendicitis 
due  to  the  above-named  anatomical  relations,  then  the  patient  will 
experience  pain  when  we  press  with  the  left  hand  upon  Mc- 
Burney's  point.  By  this  means  appendicitis  can  be  diagnosed 
while  it  is  still  in  an  early  stage,  and  the  life  of  many  may  be 
saved  before  it  is  too  late,  and  we  know  only  too  well  how 
rapidly  this  treacherous  disease  can  lead  to  a  premature  death. 

Having  made  the  diagnosis  in  the  above  mentioned  way, 


Prevention  of  Appendicitis.  195 

we  should  prohibit  all  active  movements,  especially  running, 
cycling,  etc.,  and  take  special  care  to  have  a  daily  bowel  movement 
by  the  use  of  a  suitable  diet  and  those  other  means  previously 
mentioned. 

Pain  in  the  appendicular  region  may  be  of  a  very  pro- 
nounced character,  and  yet  there  may  be  no  appendicitis,  for  it 
may  be  caused  by  inspissated  faeces.  The  presence  of  stagnating 
faecal  matter  often  induces  the  formation  of  gas,  and  by  the  dis- 
tention so  caused  the  intestinal  nerves  are  irritated  and  thus  pain 
occasioned. 

We  can  distinguish  between  appendicitis  and  pains  follow- 
ing colics,  caused  by  flatulency,  by  giving  carminatives,  such  as 
the  decoction  of  different  carminative  herbs  called  Aqua  Carmin- 
ativa  Regia,  which  is  much  used  in  Germany  and  Austria,  where 
it  is  an  official  preparation  of  the  Pharmacopoeia  Austrica  and 
Germanica.  A  few  tablespoonfuls  of  this  decoction  will  produce 
free  passage  of  gas,  after  which,  in  the  case  of  flatulent  colic,  the 
pain  will  disappear,  especially  if  we  add  a  purgative  and  clear  the 
intestines.  Of  course,  in  appendicitis  the  pain  will  not  disappear 
after  the  use  of  carminatives. 

Besides  the  foregoing  very  frequent  causes  of  appendicitis 
there  are  a  few  others  to  deal  with,  all  of  which  here  is  out  of 
the  question ;  our  intention  is  to  confine  ourselves  to  mentioning 
some  of  the  more  frequent  causes  and  not  to  deal  exhaustively 
with  the  subject,  which  can  be  found  in  the  various  hand-books 
on  surgery.  Yet  we  should  like  to  mention  one  cause  that  is  not 
infrequent,  and  this  deals  with  the  relation  between  the  tonsils  and 
the  appendix.  If  we  examine  these  organs  histologically,  we 
shall  find  that  both  are  of  the  same  lymphoid  tissue,  and,  indeed, 
some  writers  go  so  far  as  to  term  the  appendix  the  tonsil  of  the 
intestine. 

Now  we  can  often  observe  that  when  one  of  the  lymphoid 
structures  is  changed,  the  others  may  follow;  and  this  shows 
that  just  as  the  ductless  glands  are  in  close  relation  to  one 
another,  so  also  the  ductless  glands  and  the  lymphoid  structures 


196  Old  Age  Deferred. 


stand  in  close  mutual  connection,  as  we  have  mentioned  in 
previous  works,  emphasizing  the  fact  that  the  tonsils  are  often 
much  enlarged  in  myxoedema,  Graves's  disease,  acromegaly, 
diabetes,  etc. 

In  addition  to  these  intimate  relations  there  are  also  other 
causes  arising  from  the  tonsils  that  affect  the  appendix.  Such  is 
the  case  when  the  tonsils  are  inflamed  and  infectious  matter  aris- 
ing therefrom  reaches  the  intestines.  The  cause  of  appendicitis 
from  such  a  source  has  been  confirmed  by  the  bacteriological  ex- 
aminations of  Professors  Lanz  and  Tavel.  Indeed,  clinically,  we 
can  often  see  that  appendicitis  has  been,  in  quite  a  number  of 
cases,  the  result  of  previous  tonsillitis,  this  in  turn  often  being 
caused  by  the  secretion  from  the  inflamed  posterior  part  of  the 
nose  coming  in  contact  with  the  tonsils,  as  has  been  previously 
stated. 

Very  frequently  such  a  condition  exists  in  conjunction  with 
adenoid  vegetations,  and  this  explains  the  error  into  which  Del- 
cour  has  fallen  in  his  book  on  the  relation  of  adenoid  vegetations 
to  appendicitis,  in  which  he  attributes  the  immediate  cause  of  the 
latter  to  a  state  induced  by  an  insufficiency  of  the  thyroid  gland. 
We  can  often  observe  that  adenoid  vegetations  can  exist  with  a 
good  thyroid  and  vice  versa,  although  we  cannot  deny  the  fact 
that  in  children  with  thyroid  insufficiency  adenoid  vegetations 
are  frequent. 

It  is  very  probable  that  the  first  mentioned  causes  of  appen- 
dicitis and  the  last  named  often  go  together,  the  one  assisting 
and  developing  the  other.  The  unfavorable  anatomical  position 
and  constipation,  together,  offer  a  very  favorable  soil  in  which, 
through  bacterial  co-operation  after  tonsillitis,  influenza,  or  other 
infectious  diseases,  this  much  dreaded  disease  can  develop. 

By  a  slight  operation  life  is  often  saved.  The  pity  is  that 
such  aid  is  often  invoked  too  late. 


CHAPTER  XXI. 

On  the  Elimination  of  Toxic  Products  Through 
the  Kidneys. 

In  the  course  of  this  work  we  have  frequently  insisted  on 
the  fact  that  we  are  being  continually  poisoned  during  the  proc- 
esses of  life,  either  by  poisons  coming  from  without  into  our  body 
through  food  or  drink,  or  by  toxic  substances  being  formed  in 
our  body  through  defective  metabolism.  We  have  a  series  of 
glands  with  internal  secretions  which  have  properties  antagonistic 
to  these  poisons,  the  most  important  of  such  glands  being  the 
thyroid,  parathyroid  glands,  adrenals  and  the  liver,  which  act  by 
destroying  these  injurious  products. 

The  following  can  now  happen :  Either  these  toxic  products 
may  be  produced  in  such  enormous  quantities  that  even  the  in- 
creased functions  of  these  glands  will  be  insufficient  to  overcome 
them,  or  the  glands  may  not  be  in  a  condition  of  complete  in- 
tegrity. In  either  of  these  cases  the  bulk  of  these  poisons  will  be 
carried  to  the  eliminating  organs  to  be  dealt  with,  viz. :  the  skin, 
the  intestines,  and  the  kidneys. 

As  we  shall  see,  the  skin  alone  is  not  able  to  eliminate  more 
than  a  certain  portion  of  these  products,  even  by  the  additional 
assistance  of  perspiration.  In  addition  to  the  skin  the  intestines 
may  also  assist  the  work  of  the  kidneys,  by  expelling  principally 
the  poisons  from  the  digestive  organs.  But  only  a  small  portion 
of  the  poison  circulating  in  the  blood  will  be  eliminated  in  this 
way,  especially  if  there  is  a  lazy  action  of  these  organs.  Thus 
the  great  bulk  of  all  these  products  is  carried  to  the  kidneys, 
which  are,  indeed,  our  most  important  organs  for  the  elimina- 
tion of  toxic  products  from  the  blood. 

It  is  furthermore  important  to  consider  the  kidneys  because 
they  are  also  glands  with  internal  secretion.     This  is  evident  from 

(197) 


198  Old  Age  Deferred. 


the  fact  that  uraemia  is  a  condition  which  is  dependent  upon  the 
absence  of  such  a  secretion.1  It  is  not  caused  only  by  the  reten- 
tion of  urine  and  the  urea  contained  therein,  for  cases  have  been 
noted  where  there  has  been  no  urine  for  as  long  a  time  as  seven 
days,  and  yet  there  was  no  uraemia,  whereas  uraemia  rapidly  de- 
velops at  times  in  spite  of  an  abundant  flow  of  urine  and  elimina- 
tion of  urea.  Thus,  logically,  uraemia  must  be  ascribed  to 
another  factor,  which  can  only  be  the  absence  of  an  internal 
secretion  from  the  kidneys,  which  may  otherwise  perfectly  per- 
form their  work.  Another  convincing  proof  of  this  statement  is 
the  fact  that  we  are  able  to  treat  with  great  effect,  as  we  have 
personally  observed,  diseased  kidneys  with  extracts  from  the 
kidneys  of  pigs.  We  will  demonstrate  the  action  of  this  in  a 
separate  chapter. 

That  the  kidneys  are  glands  with  internal  secretion  has 
been  proved  already  by  Brown-Sequard,2  Meyer,3  and  other 
authors,  among  whom  we  will  mention  as  two  of  the  last  authori- 
ties on  this  question,  Professor  Senator  and  Professor  Hermann 
Strauss. 

The  kidneys,  being  glands  with  internal  secretion,  must 
then  stand  in  close  relation  to  the  other  ductless  glands,  accord- 
ing to  the  law  established  by  us  in  our  previous  works.  As 
already  mentioned,  we  have  shown  in  a  communication  to  the 
Paris  Biological  Society,  February  25,  1907,  that  these  glands 
have  an  intimate  relation  to  the  thyroid  gland,  and  vice  versa. 
Thus,  alterations  of  the  thyroid  always  produce  changes  in 
the  condition  of  the  kidneys.  These  alterations  in  the  kidneys 
may,  however,  not  necessarily  be  based  on  the  intimate  relations 
between  thyroid  and  kidneys  as  ductless  glands,  but  may  be  pro- 
duced by  the  fact  that,  when  the  thyroid  is  degenerated  and 
cannot  destroy  toxic  products,  these  poisonous  matters  will  be 
thrown  on  the  kidneys    (the  skin  and  intestines  not  being  of 


1  Senator :     hoc.  cit.,  and  others. 

2  Brown-Sgquard :     Archives  de  physiologie  norm,  et  path.,  p.  778,  1893. 

3  Meyer:     Ibid,,  p.  179,  1894. 


Toxic  Products  and  the  Kidneys.  199 

assistance  under  such  conditions)  and  eliminated  by  them. 
Naturally  the  passage  of  such  poisonous  products  through  the 
kidneys  is  liable  to  produce  changes  in  them,  and  albuminuria 
and  hyaline  or  granular  casts  may  show  themselves  in  con- 
sequence. 

The  same  may  also  happen  after  changes  in  the  liver. 
When  this  important  organ  is  not  able  to  destroy  poisons  they 
are  carried  in  increased  quantities  to  the  kidneys,  whence  their 
passage  will  produce  albuminuria  and  hyaline  and  granular  casts, 
as  has  been  especially  described  by  such  French  authorities  as 
Huchard,  Teissier  of  Lyons,  Moliere  and  Gouget,  etc.,  as  occur- 
ring in  diseases  of  both  liver  and  gall-ducts. 

The  appearance  of  albuminuria,  and  even  of  hyaline  casts, 
must  be  taken  as  a  proof  of  an  abnormal  condition  of  the  kid- 
neys, and.  this  notwithstanding  numerous  authorities  who  are 
inclined  to  regard  such  an  occurrence  in  a  more  lenient  way. 
We  hold,  with  Professor  Senator,  that  the  permanent  presence 
of  such  elements  in  the  urine  is  the  proof  of  the  fact  that  the  kid- 
neys are  not  in  a  normal  condition.  Even  the  orthostatic  album- 
inuria of  quite  healthy  persons,  which,  as  its  name  implies,  only 
occurs  when  such  persons  have  been  standing  for  a  time  in  an 
upright  position,  has  been  considered  by  Senator  as  an  expression 
of  the  existence  of  certain  changes  in  the  kidneys.  According  to 
Senator,  the  hyaline  casts  also  are  not  such  an  innocuous 
symptom  as  certain  authorities  claim,  but  they  are  formed  from 
the  degeneration  of  the  convoluted  tubules.  This  is  the  most  im- 
portant element  of  the  kidneys,  for  the  greater  part  of  the  solids 
and  toxins  are  excreted  by  its  cells  from  the  blood,  and  besides 
this  function  these  epithelial  cells  also  have  an  internal  secretion. 
The  appearance,  therefore,  of  hyaline  casts  (which,  as  Senator 
found,  could  be  proved  under  the  microscope  as  having  been 
formed  through  degeneration  of  the  epithelial  cells)  must  be 
considered  as  evidence  of  the  loss  of  the  secreting  portion  of  the 
kidneys  and  of  the  destruction  of  their  most  important  elements, 
and  can  be  found  regularly  in  all  the  toxic  processes  that  take 


200  Old  Age  Deferred. 


place  in  the  body,  showing  that  the  poisonous  products  of  these 
processes  have  passed  through  the  kidneys  and  been  eliminated. 

Thus  we  find  albuminuria  and  casts,  and  even  signs  of  a 
serious  inflammation  of  the  kidneys,  in  different  infectious  dis- 
eases, and  even  after  tonsillitis ;  also  after  other  toxic  conditions 
caused  by  the  secretion  of  toxic  products  in  the  body  from  certain 
ductless  glands,  such  as  the  sexual  glands  during  puberty  and  the 
thyroid  gland  in  Graves's  disease.  Likewise  in  certain  diseases 
where  waste  products  of  metabolism  cause  uric  acid  to  be  formed 
in  large  quantities,  as  also  in  diabetes,  where  a  quantity  of  other 
toxic  products,  besides  uric  acid,  are  produced. 

From  the  foregoing  it  is  only  natural  to  expect  that  dif- 
ferent toxic  products  which  are  introduced  into  the  organism 
from  without,  either  in  the  food  or  in  the  drink,  or  which  result 
from  the  decomposition  of  meat  and  alcohol  and  other  stimulants, 
will  also,  for  the  most  part,  be  eliminated  by  the  kidneys,  espe- 
cially with  a  dilatory  performance  of  the  other  disintoxicating 
organs.  When  passing  in  large  quantities,  or  sometimes  even 
in  smaller  numbers,  they  may  be  able  to  irritate  the  fine  epi- 
thelia  of  the  tabula  epithelia  and  also  those  of  the  glomeruli, 
and  produce  casts  (hyaline  ones  especially)  and  albuminuria. 
After  large  quantities  of  alcohol  such  a  condition  can  even  become 
permanent  if  the  other  toxin-secreting  organs  are  sluggish. 

In  his  experiments  on  animals  Penzoldt  has  produced  albu- 
minuria by  means  of  English  mustard,  pepper,  and  particularly 
radishes,  and  still  more  so  after  black  tea.  Gunzburg  noted  this 
also  in  a  boy  of  13,  and  Roth  in  a  child  of  ^A,  in  both  cases  after 
the  use  of  black  tea. 

Albuminuria  and  casts  can  frequently  be  observed  after  the 
administration  of  drugs  in  degrees  varying  according  to  the 
toxicity  of  the  drugs.  We  have  published  a  case  in  which  even 
epithelial  cells  of  the  kidneys,  single  and  in  casts,  as  well  as 
blood-casts  in  quantities,  have  been  found  after  an  administration 
of  chloride  of  potassium.  Luttje  found  casts  in  33  cases  out  of 
207,  and  in  92  of  these  albuminuria,  after  the  administration  of 


Toxic  Products  and  the  Kidneys.  201 

salicylates,  and  he  issues  a  warning  against  their  continual  usage. 
That  the  same  occurrence  has  also  been  observed  after  the  use 
of  other  poisonous  drugs  such  as  mercury,  chloroform,  etc.,  will 
only  appear  to  us  as  natural. 

The  skin  and  intestines,  which  co-operate  continually  with 
the  kidneys,  are  able  to  do  a  part  of  the  work  of  the  latter  by 
eliminating  poisons  which  otherwise  would  have  been  carried  to 
the  kidneys,  injuring  the  delicate  structures  by  which  they  are 
secreted  and  through  which  they  pass.  As  will  be  found  in  the 
chapter  on  the  functions  of  the  skin,  this  tissue  is  able  to  eliminate 
(especially  when  its  functions  are  increased,  as  in  cases  of  perspi- 
ration) a  part  of  the  harmful  products,  among  them  being  some  of 
the  nitrogenous  end-products  of  metabolism,  and  also  common 
salt.  But  when  the  skin  is  unclean  and  its  pores  are  clogged  by 
dirt  and  the  products  of  perspiration,  and  when  it  is  diseased,  as 
in  skin  diseases,  or  when  it  is  burnt  extensively  and  the  sudorific 
glands  destroyed,  then  these  poisonous  products  are  directed  to 
the  kidneys,  whose  secreting  structure  will  naturally  be  injured  by 
their  passage. 

The  same  may  also  happen  after  an  obstruction  or  hindrance 
to  the  intestinal  functions.  When  the  passage  of  faecal  matter  is 
retarded  for  a  long  time,  a  re-absorption  of  toxic  matters  can 
take  place  by  the  blood,  necessitating  their  elimination  by  the 
kidneys,  with  harmful  consequences  to  these  important  organs. 
This  has  been  proved  by  experiments  made  by  Wallerstein,  who 
mechanically  closed  the  anus  of  rabbits  and  dogs.  After  but 
twenty-four  hours  he  found  albuminuria  and  different  kinds  of 
casts  in  the  rabbits',  and  casts  only  in  the  dogs'  urine.  It  is  very 
important  evidence  in  favor  of  our  supposition  that  the  convo- 
luted tubules  of  the  kidneys  play  the  most  important  part  in  the 
excretion  of  harmful  products  from  the  blood,  that  Wallerstein 
found,  after  four  days,  that  the  greatest  change  had  occurred  in 
the  convoluted  tubules  of  the  kidneys  in  these  animals.  The 
epithelial  cells  of  these  tubules  were  greatly  degenerated  and  in  a 
state  of  coagulation  necrosis. 


202  Old  Age  Deferred. 


Similarly  English4  has  found  albuminuria  and  casts  in  cases 
of  strangulated  hernia  in  men,  in  consequence  of  the  stagna- 
tion of  the  contents  of  the  intestines  and  the  re-absorption 
of  toxic  matters.  Similar  results  may  also  occur  according  to 
Leichtenstein,  Senator,  Jaffe,  etc.,  in  cases  of  intussusception, 
incarceration,  and  similar  pathological  conditions. 

Thus  we  can  all  easily  understand  how  the  stagnation  of 
the  intestinal  contents,  as,  for  instance,  in  chronic  habitual  con- 
stipation, may  also  be  injurious  to  the  kidneys;  and,  indeed, 
Kobler  and  Huler  have  described  albuminuria  as  a  consequence 
of  constipation.  Not  only  is  the  elimination  of  excrementitious 
substances  checked,  but  there  is  reabsorption  of  poisonous  prod- 
ucts from  the  intestinal  contents  which  the  kidneys  must  excrete. 

That  poisonous  products  coming  from  the  intestinal  tube 
are  apt  to  produce  even  serious  changes  in  the  kidneys  has  been 
proved  by  Heller  and  Fishel  after  catarrhs  of  the  stomach  and 
intestines.  At  the  same  time  we  will  also  mention  that  in  cases 
of  intestinal  autointoxication  we  can  also  observe  a  diminution 
in  the  quantity  of  urine,  as  noted  by  several  authors,  of  whom 
we  specially  mention  Boas  and  Hemmeter.5 

From  the  foregoing  there  can  be  no  doubt  that  most  of  the 
toxic  products  in  the  blood  are  eliminated  by  the  kidneys.  This 
is  also  the  manner  in  which  the  nitrogenous  end-products  of 
metabolism  leave  the  body.  The  kidneys  act  as  a  kind  of 
filter  for  these  products.  When  the  kidneys,  however,  are 
changed  or  degenerated  by  the  formation  of  connective  tissue 
and  loss  of  the  elements  of  excretion,  as  in  old  age,  then  these 
products  will  be  retained  in  a  greater  or  smaller  number,  and 
a  condition  of  autointoxication  follows,  to  which  we  have  pre- 
viously ascribed  a  great  role  in  the  pathology  of  old  age.  Log- 
ically, if  we  wish  to  prevent  old  age  coming  on  too  soon,  or  a 
diminution  of  our  chances  for  a  long  life,  we  must  do  our  best 
to  prevent  such  a  diseased  condition. 


4  Oesterr.  Med.  Jahrbuch,  No.  2,  1884. 

5  Hemmeter :     hoc.  cit. 


CHAPTER  XXII. 

Hygiene  of  the  Kidneys,  and  the  Prevention  of 
Renal  Disease. 

The  most  rational  hygiene  of  the  kidneys  for  the  preven- 
tion of  kidney  diseases  consists  in  the  avoidance  of  all  those 
causes  which  are  injurious  to  the  kidneys,  and  which  we  have 
mentioned  in  the  previous  chapter.  A  great  part  of  the  poi- 
sonous products  that  are  eliminated  by  the  kidneys  are  intro- 
duced with  the  food  and  beverages,  and  it  is  important  for 
us  to  bear  in  mind  the  fact  that  what  we  eat  or  drink  must  pass 
through  our  kidneys,  and  that  the  structure  of  these  organs  is 
delicate;  that  the  most  important  secreting  parts  are  composed 
of  fine  epithelium  which  can  easily  be  desquamated  by  the  pas- 
sage of  irritating  products.  Thus  we  note  the  appearance  of 
hyaline  casts  after  different  kinds  of  spices  and  stimulating 
liquors,  especially  if  taken  in  large  quantities. 

There  are  many  members  of  the  profession  who  attach  no 
importance  to  the  occasional  appearance  of  a  hyaline  cast.  But, 
considering  the  finding  of  Professor  Senator1  that  such  casts 
are  formed  by  degeneration  of  the  tubular  epithelium,  we  can- 
not take  such  a  lenient  view ;  for  even  if  we  find  only  one  cast 
in  two  or  three  microscopic  specimens,  we  must  realize  how 
many  thousands  of  these  there  may  be  in  a  liter  of  urine.  Thus 
every  day  thousands  of  these  casts,  and  in  a  year  enormous  quanti- 
ties, may  be  lost.  But  as  each  cast  means  the  loss  of  important 
secreting  elements,  there  can  be  no  doubt  that,  after  a  certain 
time,  we  shall  have  lost  an  important  part  of  these  most  impor- 
tant organs,  whose  place  is  taken  by  connective  tissue.  Thus 
the   development  of  interstitial  nephritis   can  be   hastened   by 

i  Senator :    hoc.  cit. 

(203) 


204  Old  Age  Deferred. 


faults  in  our  alimentary  regime.  In  cases  where  meat  is  taken 
abundantly  it  is  most  probable  that  the  continual  excretion  from 
the  blood  of  nitrogenous  end-products  of  metabolism  means  a 
serious  overwork  for  the  kidneys  and  grave  damage  to  their 
epithelium.  And  still  more  so  if,  owing  to  a  diminished  activity 
of  the  liver  due  to  senile  degeneration,  toxic  products  of  a  higher 
toxicity  than  urea,  and  even  uric  acid,  are  passed. 

We  have  observed  the  great  frequency  of  albuminuria  and 
casts  in  the  urine  of  persons  who  were  addicted  for  many  years 
to  a  plentiful  meat  diet.  According  to  Dr.  James  Tyson,2  who  has 
been  for  many  years  making  accurate  observations  on  diseases 
of  the  kidneys,  and  who  has  published  a  standard  work  on  them, 
interstitial  nephritis  can  be  produced  after  the  prolonged  inges- 
tion of  much  meat.  If  we  wish  to  keep  our  kidneys  in  the  best 
condition,  a  lacto-vegetarian  diet  with  only  little  meat,  once  a 
day,  is  the  most  suitable.  Still  more  than  meat,  bouillon  and 
meat  gravies  should  be  avoided,  since  they  contain  irritating 
meat  extracts. 

Milk  diet  in  abundance  is  not  only  indicated  in  liver  dis- 
ease, but  also  in  chronic  kidney  troubles.  But  when  there  are 
coexisting  changes  in  the  circulatory  system,  milk  should  not 
be  given  in  large  quantities,  but  in  smaller  amounts.  Milk  has 
also  the  great  advantage  of  being  a  strongly  diuretic  substance, 
especially  in  its  acidulated  forms  (yogurth  or  kefyr,  or  simple 
sour  milk)  ;  and  at  the  same  time  it  irritates  the  kidneys  very 
little,  since  it  contains  only  a  minute  amount  of  common  salt. 

According  to  Bunge,  we  take  decidedly  too  much  salt  every 
day,  and  in  this  way  we  injure  our  kidneys  considerably. 
Achard,3  Strauss,4  Vidal  and  Javal,5  and  simultaneously  H. 
Strauss,  have  found  that  diseased  kidneys  (especially  in  acute 
or  chronic  parenchymatous  inflammations)   are  unable  to  elimi- 


2  Tyson :     A  treatise  on  "Bright's  Disease  and  Diabetes,"  second  edition, 
London,  1904. 

3  Achard:     Presse  mgd.,  1901. 

4  Strauss :     "Die  chronischen  nierenentzundungen,"  Berlin,  1902. 

5  Vidal  et  Javal:     Soc.  Med.  des  Hopitaux,  Juil.  31,  1903. 


Prevention  of  Renal  Disease.  205 

nate  sodium  chloride  properly,  and  its  retention  leads  to 
oedema.  According  to  these  authorities,  cedema  is  caused  by  a 
retention  of  water  and  sodium  chloride,  the  retention  of  the 
latter  playing  the  primary  role,  whereas  according  to  Alexander 
Koranyi,  Richter,  Kovesi,  and  Roth-Schulz,  the  retention  of  the 
water  is  the  primary  factor. 

For  these  reasons  salt  should  only  be  taken  in  very  small 
quantities.  Alcohol  should  also  be  avoided,  except  in  small 
quantities,  as  being  very  injurious  to  the  kidneys;  and  consid- 
ering that  chronic  nephritis  may  be  caused  by  the  immoderate 
use  of  alcohol,  Bunge  thinks  that  the  chronic  nephritis  following 
large  quantities  of  alcohol  may  be  attributed  to  the  fact  that, 
according  to  the  researches  of  Keller,6  made  in  Bunge's  labora- 
tory, the  alcohol  habit  leads  to  an  immoderate  use  of  salt  with 
its  deleterious  effects  upon  the  kidneys. 

According  to  Bunge,  rice  gives  very  little  work  to  the  kid- 
neys, as  in  twenty-four  hours  only  2  grammes  of  alkaline  salts 
are  eliminated.  On  the  other  hand,  potatoes  cause  a  very  great 
elimination  of  salt  by  the  kidneys.  Bunge  thinks  that  rice  would 
be  a  good  food  for  patients  with  renal  disease. 

Not  only  alcohol,  but  other  stimulants,  like  tea,  can  be  of 
harm  to  the  kidneys  if  taken  in  large  quantities,  as  we  have 
mentioned  in  the  preceding  chapter  when  speaking  of  black  tea. 

We  do  not  think,  however,  that  the  daily  use  of  black  tea, 
in  moderate  quantities,  would  have  unfavorable  effects  on  the 
kidneys.  Its  relation  to  the  production  of  uric  acid  should,  how- 
ever, be  remembered  (see  chapter  on  other  stimulants:  coffee, 
tea,  tobacco,  etc.). 

For  reasons  already  mentioned,  irritating  spices  and  adul- 
terated sauces  should  be  very  carefully  avoided;  also  all  kinds 
of  food  which  contain  pungent  ingredients.  We  have  no  doubt 
that  by  their  use  life  is  often  shortened.  The  passage  of  such 
poisonous  substances  for  years  through  our  kidneys  must  injure 


6 Keller:     Zeitschrift  fur  Physiol.  Chemre,  vol.  xiii,  p.  130  and  134,  1889. 


206  Old  Age  Deferred. 


their  delicate  structure  and  hasten  the  development  of  the  senile 
kidneys,  with  interstitial  nephritis. 

It  is  advisable  to  drink  plenty  of  water,  especially  when 
much  meat,  or  the  above-mentioned  sauces,  are  eaten.  By  this 
means  we  can  flush  out  of  our  kidneys  the  end-products  of 
proteid  food,  and  also  other  toxic  substances.  For  the  same 
reason  ^it  is  well  to  use  certain  mineral  waters  with  diuretic 
properties.  They  should,  however,  not  be  taken  at  the  same 
moment  as  substances  irritating  to  the  kidneys  are  taken,  or  the 
kidneys  may  be  so  injured  that  acute  haemorrhagic  nephritis  may 
ensue.  We7  have  published  such  a  case,  where  even  small  quan- 
tities of  chloride  of  potassium  taken  on  an  empty  stomach, 
together  with  Wildungen  waters,  which  have  very  diuretic 
properties,  provoked  a  condition  of  acute  nephritis,  with  great 
quantities  of  blood  clots,  epithelial  and  granular  casts,  many 
epithelial  cells,  and  red  and  white  blood-corpuscles  in  the  urine. 

When  taking  various  drugs,  we  must  always  remember 
that  they  must  pass  through  our  kidneys.  The  drug  habit, 
especially  when  irritating  drugs  are  taken,  can  have  a  ruinous 
effect  on  these  vital  organs  and  surely  diminish  our  prospects 
for  a  long  life.  Day  by  day  many  of  the  epithelial  cells  will  be 
desquamated,  slowly  but  surely,  and  inflammatory  conditions  of 
the  kidneys  will  eventually  appear.  There  is  nothing  in  this  world 
without  a  cause,  and  if  a  chronic  parenchymatous  or  inter- 
stitial nephritis  suddenly  appear,  it  must  have  a  pre-existing 
cause.  It  is  the  result  of  our  continual  neglect  and  abuse  of  these 
most  important  organs.  As  Prof.  Friedlich  Miiller  said  a  few 
years  ago,  the  kidneys  never  forget  the  wrong  they  once  have 
suffered.  Indeed,  most  of  the  evil  that  befalls  us  in  this  world 
is  our  own  fault,  for  doing  things  we  should  not  do  and  omitting 
those  we  should. 

A  frequent  source  of  renal  diseases  is  infectious  diseases 
with  the  passage  of  toxic  products  through  the  kidneys.  This 
source  of  kidney  disease  is  often  overlooked,  the  symptoms  of 

7  Journal  med.  de  Bruxelles,  1903. 


Prevention  of  Renal  Disease.  207 


acute  nephritis  being  mistaken  for  or  confused  with  those  of 
the  infectious  disease.  Acute  nephritis  after  tonsillitis  is  often 
not  diagnosed  unless  the  symptoms  are  very  marked.  In  such 
cases  occasional  casts  and  epithelial  cells,  with  red  and  white 
blood-corpuscles,  may  remain  for  a  long  time  in  the  urine,  some- 
times permanently,  and  thus  slowly  and  insidiously  chronic  neph- 
ritis develops. 

Tonsillitis  is  often  caused  by  the  dropping  upon  the  tonsils 
of  mucous  secretion  from  a  post-nasal  catarrh.  This  is  com- 
monly so  in  chronic  rhinitis  caused  by  adenoid  vegetations.  The 
best  prevention  of  renal  diseases  in  these  cases  is  operation  on 
the  vegetations  and  treatment  of  the  rhinitis,  rather  than  removal 
of  the  tonsils,  which  probably  play  a  great  role  in  the  defense 
of  the  organism  against  infections.  This  is  shown  by  the  fact 
that  they  are  inflamed  in  the  early  stages  of  many  infectious 
diseases. 

The  greatest  care  must  be  given  to  the  condition  of  the 
skin  and  intestines,  if  we  wish  to  keep  our  kidneys  in  good  order 
and  prevent  their  deterioration.  We  must  try  to  eliminate 
through  the  skin  and  intestines  as  many  as  possible  of  the  toxic 
substances  which  otherwise  would  make  their  way  to  the  kid- 
neys and  increase  their  work,  and  perhaps  injure  their  epithe- 
lium.    In  this  way  we  can  save  our  kidneys  for  their  time  of  need. 

Therefore,  the  skin  and  intestines  should  be  kept  in  good 
working  order.  We  must  do  all  we  can  to  maintain  the  func- 
tion of  the  skin,  and  in  several  chapters  of  this  book  we  have 
considered  this  question.  We  will  only  mention  briefly  that 
the  invisible  perspiration  of  the  skin  should  be  encouraged  as 
much  as  possible.  Damp  and  cold  weather  are  apt  to  suppress  it. 
In  such  weather  our  skin  also  gives  off  too  much  warmth,  there- 
fore we  should  be  warmly  clad,  wool,  especially  for  old  persons, 
being  best.  Still  more  important  is  this  when  the  kidneys  are 
already  damaged.  For  such  persons  a  warm  climate  is  advisable. 
By  increasing  the  perspiration  to  sweating,  products  which  are 
harmful  to  the  kidneys  may  be  eliminated.     Hence  such  pro- 


208  Old  Age  Deferred. 


cedures  will  take  work  off  the  kidneys  and  rid  them  of  injurious 
substances.  The  sweating  should  be  done  frequently,  at  least 
once  a  week,  if  we  want  to  keep  our  kidneys  in  good  condition. 
For  fuller  particulars  on  the  hygiene  of  the  skin,  and  also  of 
the  intestines,  we  refer  to  the  chapters  relative  to  these  questions. 


CHAPTER  XXIII. 

On  the  Elimination  of  Toxic  Products  Through 
the  Skin. 

There  are  some  two  and  a  half  million  small  glandular 
formations — the  sudorific  glands — on  the  whole  surface  of 
the  body  in  the  subcutaneous  tissue  of  the  skin,  from  which 
issues  a  secretory  tube  somewhat  of  the  nature  of  a  corkscrew 
to  the  external  surface  of  the  skin. 

These  glands  are  richly  provided  with  blood-vessels,  and 
a  comparison  may  be  drawn,  to  a  certain  extent,  between  the 
glomerules  of  the  kidneys  and  these  small  glandular  formations. 
The  first  receive  certain  substances  from  the  blood  and  give  it 
off  through  the  tubules  which  carry  away  the  urine,  and  the 
latter  take  both  fluid  and  solid  substances  from  the  blood  and 
eliminate  it  in  the  form  of  sweat  through  the  excreting  chan- 
nels of  the  sudorific  glands. 

Gas  can  also  be  eliminated  through  the  skin — carbonic  acid 
— though  in  infinitely  smaller  quantity  than  by  the  lungs,  for 
while  the  latter  eliminate  from  800  to  1200  grammes  of  carbonic 
acid,  it  has  been  shown  by  the  experiments  of  Aubert1  that  a 
human  being  eliminates  through  the  skin  a  maximum  of  6.3 
grammes  and  a  minimum  of  2.3  grammes  in  twenty-four  hours, 
which  is  certainly  a  very  small  quantity.  Besides  carbonic  acid 
the  skin  probably  also  eliminates  other  organic  combinations  in 
the  form  of  gas,  though  it  would  be  very  difficult  to  analyze 
them  by  exact  experiments.  Pettenkoffer  was  able  to  demon- 
strate from  experiments,  that,  if  many  persons  are  in  a  confined 
place,  it  is  not  carbonic  acid  alone  that  causes  the  very  disagree- 
able sensation  of  the  foul  air,  but  that  it  is  a  consequence  of 


1  Aubert:     Pfliiger  Archiv,  vol.  vi,  p.  539,  1872. 

"  (209) 


210  Old  Age  Deferred. 


the  accumulation  of  harmful  products  of  perspiration  through  the 
skin,  the  particular  nature  of  which  has  not  been  determined 
as  yet. 

On  this  account  it  is  permissible  to  speak  of  a  respiration 
through  the  skin,  although  it  has  not  yet  been  demonstrated 
by  exact  methods  that  the  skin  is  really  absorbing  small  quanti- 
ties of  oxygen ;  and  it  is  even  now  not  yet  beyond  doubt  whether 
the  small  amount  of  carbonic  acid  may  not  be  ascribed,  perhaps, 
to  the  decomposition  of  the  excretions  from  the  skin,  and  of 
the  epidermis  that  is  shed,  as  stated  by  Prof.  Bunge.2 

But  if  it  is  not  possible  to  prove  the  certainty  of  respiration 
through  the  skin  to  a  degree  that  would  satisfy  the  postulates 
of  exact  science,  on  the  other  hand  the  observations  of  ancient 
savants,  whose  chemical  knowledge  and  powers  of  observation 
were  not  inferior  to  those  of  their  present  successors,  in  spite  of 
a  deficient  education  in  chemistry,  all  point  to  its  existence,  and 
we  shall  have  to  take  it  into  account. 

As  a  rule  the  various  products  of  skin  perspiration 
cannot  be  seen,  as  they  are  eliminated  in  the  form  of  vapor. 
This  evaporation  takes  place  in  this  invisible  form,  however, 
only  when  it  is  not  checked  or  when  it  is  not  produced  in  ex- 
cessive quantity.  But  when  such  evaporation  is  hindered  by 
clothing  that  is  impermeable  to  such  products,  such  as  rubber 
clothes  or  fur,  or  when  it  is  too  abundant,  then  it  will  be 
eliminated  in  the  form  of  water  through  the  pores,  and  will 
appear  in  drops.  The  human  body  loses  from1  i  to  ij4  liters  of 
this  moisture,  that  is  to  say,  sweat,  in  a  day. 

Such  checking  of  evaporation  produces  a  very  disagreeable 
feeling,  a  fact  that  indicates  the  existence  of  skin  respiration ;  as 
does  also  the  circumstance  that  persons  clothed  in  a  way  that 
permits  of  the  circulation  of  air  to  the  skin  and  the  elimination 
of  the  products  of  perspiration,  and  who  also  use  other  means 
for  maintaining  a  good  hygiene  of  the  skin,  such  as  a  bath,  are 
always  in  better  health  than  those  who  neglect  these  points. 

2  Professor  Bunge:    Lehrbuch  der  Physiologie  des  Menschen,  Leipzig.  1905. 


Toxic  Products  and  the  Skin.  211 

That  the  retention  of  various  harmful  products  normally 
eliminated  through  the  skin  is  extremely  injurious  to  health  is  best 
shown  by  the  fact  that  animals  whose  skin  is  varnished  all  over 
invariably  succumb  to  intoxication.  Especially  is  this  true  in 
amphibia,  who,  as  Spallanzani3  found,  can  live  longer  after  the 
removal  of  the  lungs  than  after  varnishing  the  whole  skin.  The 
cause  of  this  is  that  in  amphibia  the  respiration  by  the  skin  is 
more  important  than  that  through  the  lungs. 

But  even  if,  in  higher  animals,  there  is  far  more  respiration 
through  the  lungs  than  through  the  skin,  the  varnishing  over 
of  the  skin  on  the  entire  body  can  produce  death  in  certain  mam- 
malia. This  has  also  been  observed  to  have  occurred  in  man. 
The  day  before  the  solemn  entry  into  Rome  of  Pope  Leo  XIII,  a 
little  boy  was  painted  over  his  entire  body  with  gold  leaf  so  as 
to  represent  an  angel ;  but  he  suddenly  died  before  the  procession 
began.  We  cannot,  however,  conceal  the  fact  that  the  death  of 
higher  animals,  according  to  some  authorities,  is  not  due  to  the 
retention  of  the  products  of  perspiration,  but  rather  to  an  in- 
creased loss  of  warmth  of  the  body,  especially  as  these  animals 
have  always  been  shaved  prior  to  being  varnished. 

Still,  for  reasons  we  shall  give  later,  we  believe  that  this 
cannot  alter  our  views  on  the  harmfulness  of  checking  respira- 
tion through  the  skin.  The  injurious  action  of  this  is  also 
shown  by  the  fact  that  persons  whose  skin  is  burnt  to  a  large 
extent,  die,  as  a  rule,  by  intoxication.  Certain  opinions  have  been 
advanced  which  ascribe  such  a  death  to  a  change  in  the  consti- 
tution of  the  blood  after  extensive  burns.  I  am  inclined  to  think 
that  death  may  be  due  to  the  fact  that  the  skin  respiration  is, 
in  such  a  case,  more  suppressed,  as  the  body  is  enveloped  in 
bandages  which,  like  sticking  plaster,  do  not  admit  of  air  circu- 
lation; and  also  because  there  is  no  elimination.  At  the  same 
time  the  other  parts  of  the  body  are  covered  by  the  clothing  in- 
stead of  the  same  being  removed.  If,  however,  after  such  burns 
the  body  be  kept  quite  naked  and  the  air  thus  permitted  a  free  cir- 

3  Memorabilien  traduits  par  Levebier,  p.  77,  Geneve,  1863. 


212  Old  Age  Deferred. 


culation  on  all  sides,  then  even  after  the  most  extensive  burns 
death  will  not  follow,  as  we  have  seen  in  several  cases  so  treated 
by  Dr.  Sneve  in  St.  Paul,  Minn.,  whose  wards  we  inspected 
some  years  ago.  Why  should  the  changes  in  the  blood  not  in- 
duce death  in  these  patients  in  the  same  way  as  it  does  in 
patients  swathed  in  bandages?  Logically,  this  cannot  be  the 
reason  for  death,  but  in  all  probability  it  is  the  suppression  of 
the  skin  respiration.  But  if  death  after  extensive  burns  is  due  to 
this  cause,  then  the  same  may  be  given  as  the  cause  of  death  after 
varnishing  the  body.  The  substances  which  are  eliminated  from 
the  body  through  perspiration  are  urea,  uric  acid  (in  small  quan- 
tities only),  common  salt,  creatin,  acetic  acid,  lactic  acid,  and  a 
number  of  fatty  acids.  Although  exact  science  does  not  demon- 
strate that  poisonous  matters  are  eliminated  through  perspiration, 
still  some  very  noted  men,  like  Ortner  and  Goldscheider,  are 
convinced  of  it.  Arloing  contends  that  the  perspiration  of  even 
a  healthy  man  is  toxic,  whereas  Queirolo  admits  this  to  be  so 
only  in  the  case  of  sick  persons. 

We  shall  also  be  able  to  realize  the  great  importance  of 
the  skin  as  an  eliminating  organ  for  toxic  products  after  a  little 
consideration  on  the  origin  of  skin  diseases,  which  we  believe 
are  due  to  two  principal  causes :  Firstly,  the  invasion  of  mi- 
crobes into  the  skin  after  a  diminution  of  its  resistance,  which, 
in  turn,  is  dependent  upon  the  condition  of  its  nutrition  by 
the  blood.  This  is  the  external  cause.  Secondly,  by  the  elimi- 
nation of  toxic  products  which  are  formed  in  the  body  and  then 
pass  through  the  skin.  These  may  have  originally  been  intro- 
duced from  the  outside,  either  by  food  or  by  drugs,  or  they  may 
have  been  produced  in  the  body  through  products  arising  from 
certain  glands,  such  as  the  thyroid,  sexual  glands,  etc.  The  waste 
products  of  metabolism,  such  as  uric  acid,  may  also  be  included 
in  this  category.  This  is  the  internal  cause  of  skin  diseases. 
Both  of  these  causes  may  stand  in  relationship ;  thus  the  existence 
of  the  second  may  favor  the  development  of  the  first. 

For  the  subject  now  under  consideration  the  second  cause  is 


Toxic  Products  and  the  Skin.  213 

more  important,  and  we  will  say  a  few  words  on  the  matter  as 
showing  the  importance  of  the  skin  as  an  eliminating  organ  for 
toxic  products. 

We  may  frequently  see  persons  who  are  affected  by  erup- 
tions on  the  skin  after  eating  certain  kinds  of  food,  as  oysters 
or  strawberries;  and  especially  after  eating  oysters  which  have 
not  been  absolutely  fresh.  In  our  own  case,  and  in  many  others 
which  we  have  observed,  an  eruption  of  acne  on  the  face  has  fol- 
lowed the  eating  of  cheese.  A  similar  state  of  things  may  result 
from  taking  certain  drugs;  thus,  after  bromine  or  iodine  very 
often  acne  may  be  observed  on  the  face.  This  interesting  fact 
we  have  experienced  personally  and  have  noted  in  patients  who 
have  taken  thyroid  tablets  in  certain  quantities,  which  also 
contain  iodine. 

If  we  examine  acne  eruptions  we  find  in  them  certain  mi- 
crobes, such  as  the  bacillus  of  Unna,  etc.  In  gout,  which  is 
caused  by  the  retention  of  uric  acid,  skin  diseases  are  very 
frequent. 

Sufferers  from  Graves's  disease,  in  which  there  is,  as  has 
been  so  often  mentioned,  a  hyperactivity  of  the  thyroid  gland, 
have  very  frequently  cutaneous  eruptions,  including  acne,  and  often 
also  a  very  irritating  pruritus.  Also  in  diabetes,  in  which  thyroid 
hyperactivity  plays  a  prominent  role,  it  is  not  so  much  the  sugar  as 
the  factor  I  have  referred  to,  which  is  the  cause  of  the  great 
frequency  of  skin  diseases.  Here  also  a  number  of  toxic  prod- 
ucts are  eliminated  through  the  skin. 

In  women,  during  menstruation,  we  often  see  cutaneous 
eruptions,  as  acne  or  hives.  The  former  is  often  very  distressing 
in  boys  and  girls  in  the  years  of  puberty,  and  it  is  quite  impos- 
sible to  deny  that  this  may  be  a  symptom  of  a  hyperactivity 
of  the  sexual  glands. 

We  demonstrate  in  another  part  of  this  book  that  the  secre- 
tion of  the  sexual  glands.  We  often  observe  acne  in  persons 
who  are  masturbating,  or  who  for  a  long  time  live  in  complete 
sexual  abstinence,  so  that  in  certain  places  the  laity  term  these 


214  Old  Age  Deferred. 


"pimples  of  chastity."  Here,  again,  married  life  is  the  best 
cure  for  this  disease,  as  it  is  for  so  many  others. 

It  is  very  interesting  to  note  during  the  question  we  are  now 
discussing  that  persons  suffering  from  psoriasis  feel  relief  from 
their  affection  when  they  have  had  a  good  opening  of  the 
bowels,  or  when  they  perspire  freely;  hence  in  hot  summer 
weather  they  suffer  less  inconvenience  than  in  the  winter;  also 
by  following  a  certain  diet  this  disease  may  be  favorably  influ- 
enced; that  is  to  say,  such  persons  have  fewer  psoriatic  patches 
when  the  toxic  products  are  eliminated  by  the  intestines  or  kid- 
neys. When  there  is  a  hyperactivity  of  the  skin  function,  as  in 
perspiration,  the  toxic  products  are  eliminated  in  the  vapor  or 
moisture  of  the  perspiration,  but  during  a  diminution  of  this  func- 
tion they  form  the  psoriatic  patches. 

When  the  skin  function  is  increased,  as  in  sweating,  a  num- 
ber of  products  that  are  otherwise  eliminated  through  the  urine 
pass  through  the  skin,  which  may  eliminate  a  considerable  part 
of  the  solid  waste  products,  and  particularly  a  very  important 
chemical  product — common  salt.  When  the  kidney  is  diseased 
the  elimination  of  common  salt  and  other  substances  may  become 
difficult,  and  thus  still  more  injure  the  kidneys;  these  products, 
and  especially  the  common  salt,  will  be  retained.  Then  comes 
the  skin  to  the  assistance  of  the  kidneys.  Not  an  inconsiderable 
part  of  these  substances  may  then  pass  through  the  skin  when 
it  is  in  a  condition  of  increased  activity,  in  the  form  of  sweat. 
Thus  the  kidneys  and  skin  work  in  harmony;  they  are  com- 
panions, and  may  be  graphically  called  "Kidney  and  Co.,"  the 
skin  being  the  second  partner.  The  skin  is  thus  one  of  our  most 
important  organs,  and  in  the  following  chapter  we  will  deal 
with  its  hygiene. 


CHAPTER  XXIV. 

The  Hygiene  of  the     Skin — Air  Baths. 

In  another  part  of  this  work  we  have  attributed  to  the 
kidneys  a  very  important  part  in  the  causes  of  premature  old 
age,  as  their  degeneration  is  one  of  the  most  striking  causes  of 
auto-intoxication,  the  immediate  cause  of  old  age.  The  more 
injurious  the  products  passing  through  the  kidneys,  the  quicker 
will  these  noble  organs  be  degenerated  and  the  sooner  will  they 
decay. 

It  will  thus  be  the  wisest  policy  in  the  prevention  of  prema- 
ture old  age  and  in  the  interests  of  a  long  life,  to  lighten  the 
work  of  the  kidneys,  and  avoid  their  being  overstrained  by 
throwing  a  part  of  the  work  on  their  partner — the  skin.  This 
organ,  as  stated  at  the  close  of  the  preceding  chapter,  is,  in  a 
certain  measure,  a  co-partner  with  the  kidneys.  When,  through- 
cold  weather,  for  instance,  the  functions  of  the  skin  are  dimin- 
ished, a  greater  flow  of  liquid  will  pass  through  the  kidneys  in 
the  form  of  urine;  but  when  the  weather  is  hot  and  there  is 
perspiration,  to  a  certain  extent,  less  liquid  will  be  secreted  and 
excreted  by  the  kidneys :  that  is,  they  will  work  less.  By  per- 
spiration, also,  more  common  salt  will  pass  through  the  skin,  and 
consequently  less  through  the  kidneys. 

It  follows  logically  from  these  considerations  that  if  we  are 
anxious  to  preserve  the  vitality  of  the  kidneys  and  also  free  the 
blood  from  noxious  elements,  we  must  pay  special  attention  to 
a  good  action  of  the  skin,  and  this  is  only  possible  by  a  rational 
hygiene. 

The  sudorific  glands  are  abundantly  provided  with  small 
blood-vessels,  which  bring  a  large  quantity  of  warm  blood  to 
them,  from  which  they  absorb  watery  and  solid  parts,  and,  in  all 
probability,  gaseous  substances  also,  and  pass  them  through  their 
tortuous  excretory  channels  to  the  surface  of  the  skin.     The 

(215) 


216  Old  Age  Deferred. 


mouths  of  these  channels  are  the  pores,  and  it  is  of  fundamental 
importance  that  they  remain  open ;  for  if  closed  these  waste  prod- 
ucts cannot  pass  out  and  must  remain  in  the  body,  while  in  addi- 
tion no  air  can  pass  into  the  pores,  and  so  no  exchange  of 
materials  can  take  place. 

These  pores  can  easily  be  clogged;  for  example,  by  the 
scales — cuticle — which  we  shed  every  day,  mostly  from  the 
superficial  layers  of  the  skin,  and  also  by  the  oily  secretion  of 
the  sebaceous  glands.  The  fat  that  these  glands  secrete  is  in- 
tended by  Nature  to  serve  as  a  protection  against  liquids,  like 
water,  and  against  the  perspiration  from  the  skin.  In  some  per- 
sons this  fat  is  secreted  in  too  large  quantities  and  may  then, 
especially  with  its  products  of  decomposition,  clog  the  pores.  In 
the  same  way  the  products  of  perspiration,  and  also  foreign 
materials,  such  as  dust,  may  close  the  pores.  It  will,  therefore, 
be  necessary  to  remove  all  these  substances  which  are  prevent- 
ing the  proper  aeration  of  the  skin  and  the  elimination  of  harmful 
matters  by  it.  It  is  also  not  impossible,  when  the  products  of 
decomposition  of  the  sweat  remain  long  in  close  contact  with 
the  skin,  that  some  of  those  injurious  elements  may  be  reabsorbed. 

The  best  method  of  getting  rid  of  these  harmful  substances 
is  by  bathing  every  day.  But  water  alone,  except  it  be  very 
hot,  and  the  bath  of  long  duration  (and  in  this  case  it  presents 
some  inconvenience  and  may  be  injurious  also  to  health  if  taken 
daily),  is  not  able  to  remove  the  oily  and  fatty  products  of  the 
skin.  Therefore  it  is  best  to  use  soap  in  addition  to  water,  and 
to  rub  energetically  with  it  the  entire  skin  surface  of  the  body. 

Besides  removing,  by  a  bath,  the  injurious  products  that 
clog  the  pores,  we  must  take  particular  care  to  allow  air  to 
penetrate  to  the  pores  as  freely  as  possible,  thus  permitting  a  free 
issue  to  the  body  exhalations  and  facilitating  respiration  by  the 
skin. 

We  should  not,  therefore,  exclude  the  air  by  thick,  non- 
porous  clothing,  such  as  furs;  nor  should  we  use  underwear 
that  fits  too  closely  to  the  body.     To  permit  of  a  thorough  aera- 


Hygiene  of  the  Skin — Air  Baths.  217 

tion  of  the  skin  it  would  be  advantageous  to  remain  exposed 
naked  to  the  air  once  or  twice  during  each  twenty-four  hours, 
and  each  time  for  at  least  five  to  ten  minutes.  When  the  weather 
is  warm  and  we  bathe  in  the  sea  or  a  river,  we  combine  the  ad- 
vantages of  a  water  and  air  bath.  But  in  places  where  there  is  no 
sea,  lake,  or  river  in  which  to  bathe,  we  could,  if  living  in  the 
country,  enclose  some  spot  for  such  an  air  bath  which,  in  sunny 
weather,  would  also  become  a  sun  bath  at  the  same  time.  On 
the  grass  of  a  clearing  in  a  wood,  or  in  a  garden,  such  an  air  bath 
could  best  be  taken.  In  summer,  if  the  air  is  not  too  warm,  and 
if  we  are  in  the  sun,  we  may  remain  longer  than  ten  minutes  in 
such  an  air  bath. 

If  we  are  not  able  to  procure  a  place  in  which  such  a  bath 
can  be  taken  quite  naked  without  being  seen,  the  next  best  thing 
is  to  clothe  oneself  in  amply  large  white  pajamas,  or,  for  women, 
in  a  very  wide  white  mantle  or  costume  of  the  empire  style,  and 
thus  attired  to  take  a  walk  in  the  garden  or  ground  of  one's 
property. 

In  cities  many  can  take  such  an  air  bath  in  one  room  every 
day  when  they  can  spare  ten  minutes,  the  best  time  being  before 
dressing  and  after  undressing.  But  also  during  the  day,  espe- 
cially in  summer,  we  should  spare  a  few  moments  to  take  such 
a  bath.  In  winter  the  room  must,  of  course,  be  warmed  for  the 
purpose.  In  combination  with  the  bath,  breathing  exercises 
can  also  be  performed  to  great  advantage  in  the  way  described 
in  the  chapter  on  the  advantage  of  open  air.  In  order  to  avoid 
catching  cold  in  such  an  air  bath  it  is  advisable  to  rub  the 
entire  skin  surface  of  the  body.  This  causes  much  blood  to  be 
brought  to  the  skin ;  thus  more  blood  is  conveyed  to  the  sudorific 
glands  which  are  thereby  enabled  to  absorb  a  larger  quantity  of 
harmful  matters  from  it,  while  at  the  same  time  more  air  can  be 
taken  in  by  the  pores.  While  rubbing — which  is  best  done  by 
a  brush — we  can  also  move  about,  and  while  standing  also  beat 
the  periphery  of  the  body  with  a  thick  rough  towel  in  the  same 
way  as  in  Finland  they  do  with  brushwood  after  hot  baths.     It 


218  Old  Age  Deferred. 


is  not  painful  and  is  very  effective  in  producing  a  hyperemia 
of  the  surface  of  the  skin.  When  the  skin  is  thus  better  nour- 
ished with  blood  it  also  offers  more  resistance  to  germs  that  may 
cause  diseases  of  the  skin,  and  such  better  nutrition  and  its  im- 
proved hygienic  condition  is  a  safeguard  against  catching  cold. 

Such  an  occurrence  is  more  likely  to  occur  in  persons  who 
neglect  a  thorough  cleansing  of  the  body  daily  by  baths  and  who 
go  warmly  clad;  in  such  cases  the  muscles  which  contract  the 
pores  are  less  active,  and  because  of  this  more  body  heat  is  lost 
and  catching  cold  more  easily  takes  place.  When  we  feel  warm 
more  blood  circulates  through  the  skin,  and  when  afterward  cold 
air  reaches  us  the  pores,  in  a  normal  person,  contract  quickly  and 
the  blood  is  retained  in  the  interior  of  the  body.  Thus  we 
are  prevented  from  giving  off  too  much  warmth  from  the 
body  and  catching  cold.  Persons  who  have  been  trained  since 
their  early  childhood  to  cold  water  and  cold  air  show  a  great 
facility  for  reaction  against  cold.  When  cold  air  reaches  the 
skin,  which  on  account  of  warm  surroundings  has  become  warm, 
filled  with  blood,  red,  and  moist,  the  skin  will  contract  and 
become  pale,  the  easy  conduction  of  warmth  will  be  checked,  and 
the  heat  retained  in  the  body.  Thus  such  persons  will  not  so 
easily  catch  cold  as  others  whose  skin  is  not  kept  in  good  hygienic 
condition. 

Many  people  have  already  shortened  their  existence  by 
catching  colds.  Pneumonia,  pleurisy,  nephritis,  and  many  other 
dangerous  ailments  have  arisen  from  such  a  cause  and  led  to 
premature  death.  A  good  hygiene  of  the  skin  not  only  serves 
to  eliminate  toxic  products  from  the  body  and  keep  our  kidneys 
in  good  order,  but  also  prevents  the  tendency  to  catching  cold, 
which  is  so  often  the  cause  of  an  early  death.  We  must,  there- 
fore, do  our  best  by  a  careful  rational  attention  to  the  hygiene 
of  the  skin,  and  for  this  purpose  we  will  deal  further  with  the 
subject  in  two  chapters  on  the  hygiene  of  the  skin  by  bathing 
and  by  rational  clothing. 


CHAPTER   XXV. 
On  Rational  Clothing. 

The  chief  object  of  rational  clothing  is  to  obtain  porosity. 
All  underwear  as  well  as  outer  coverings  must  be  made  out  of 
some  porous  substance  which  will  in  no  way  check  the  perspira- 
tion from  the  body  or  the  evaporation  of  such  perspiration,  and 
which  will  at  the  same  time  allow  of  a  free  passage  of  air  to  all 
parts  of  the  body. 

First,  we  will  discuss  the  question  as  to  the  nature  of  the 
underwear  which  is  most  appropriate  for  keeping  ourselves 
in  a  healthy  condition. 

Wool  is  the  most  suitable  material  for  warmth  for  under- 
clothing, as  it  is  a  bad  conductor  of  heat  and  can  therefore  best 
retain  the  natural  heat  of  the  body.  It  follows,  therefore, 
that  this  is  the  best  for  aged  persons  to  use. 

In  old  age,  especially  when  very  advanced,  less  natural 
heat  is  produced  in  the  body.  On  account  of  the  degenera- 
tive changes  of  the  small  capillaries  the  surface  of  the  body  is 
not  so  well  provided  with  the  heating  element,  which  is  the 
blood.  At  the  same  time,  on  account  of  the  loss  in  elasticity  of 
the  musculature,  the  skin  of  an  aged  person  contracts  less  readily 
from  cold  than  does  the  skin  of  younger  people ;  thus,  while  on 
the  one  hand  less  warmth  is  produced,  on  the  other  hand  more 
warmth  may  be  given  off,  a  due  consideration  of  which  leads 
to  the  logical  conclusion  that  all  aged  persons  had  best  wear 
woolen  underclothing. 

Woolen  underwear,  though  the  best  to  retain  the  warmth  of 
the  body,  has,  on  the  other  hand,  very  serious  drawbacks.  Wool 
possesses  the  great  advantage  of  easily  absorbing  the  perspira- 
tion of  the  body;    it  can,  in  fact,  absorb  about  40  per  cent,  of 

(219) 


220  Old  Age  Deferred. 


the  moisture,  by  weight,  without  becoming  so  saturated  as  to 
be  noticeable ;  but  at  the  same  time  it  gives  off  this  moisture  again 
very  slowly,  necessitatino"  the  changing  at  once  of  such  damp 
covering. 

The  greatest  drawback  to  wool,  however,  is  that  it  soon 
loses  its  porosity  after  it  has  been  washed,  for  then  it  shrinks 
and  its  meshes  contract,  and  in  consequence  the  material  is  no 
longer  porous ;  while  in  this  condition  it  does  not  freely  give  off 
the  moisture,  but  retains  it,  the  aeration  of  the  skin  is  seriously 
hindered,  and  the  products  of  perspiration  are  not  gotten  rid  of. 

Everybody  knows  what  a  disagreeable  feeling  is  produced 
by  keeping  on  such  underwear  after  it  has  become  dampened  by 
perspiration,  and  this  is  due  to  the  prevention  of  the  dissemination 
of  the  exhalations  from  the  body.  Such  disadvantages  to  the 
wearer  of  woolen  underclothing  may  possibly  be  discounted  by 
making  such  underwear  with  large  meshes ;  but  even  in  this  case 
it  is  not  easy  to  prevent  the  loss  of  porosity  after  washing.  It 
is  therefore  advisable  to  wear  a  large  meshed  linen  garment 
next  the  skin  under  the  woolen  underclothing;  there  will  thus 
be  a  cushion  of  air  between  the  skin  and  the  woolen  garment; 
and  linen  also  has  a  great  affinity  for  absorbing  moisture  and 
rapidly  giving  it  off  again. 

All  kinds  of  underwear,  whether  of  wool  or  other  material, 
should  be  loose  about  the  body.  It  is  a  great  mistake  to  have  it 
too  tight.  There  should  always  be  a  considerable  layer  of  air 
between  the  clothing  and  the  skin.  This  layer  is  warmed  by  the 
blood  at  the  surface  of  the  body,  and  as  air  is  a  bad  conductor 
of  heat,  even  in  the  case  of  underwear  not  so  thick  as  wool, 
if  such  clothing  is  worn  somewhat  loosely  about  the  body  and 
is  porous,  we  shall  not  feel  cold.  The  porosity  of  the  tissue  per- 
mits the  entrance  of  air,  and  such  tissues,  with  air  in  their  pores, 
are  abstracting  a  minimum  of  heat  from  the  body,  though  such 
pores  in  the  tissue  allow  for  the  free  passage  and  exit  of  the 
harmful  exhalations  and  evaporations  from  the  body. 

From  the  foregoing  it  follows  that  socks  which  do  not  fit 


On  Rational  Clothing.  221 

too  tightly  but  fairly  loosely,  and  which  are  made  of  porous  ma- 
terial, such  as  good  wool,  will  also  be  the  warmest.  It  is  quite 
unnecessary  to  adopt  heavy  double  socks  which  fill  up  all  the  space 
in  the  shoes;  as  a  matter  of  fact  in  such  a  case  we  may  have 
colder  feet  than  if  we  wore  light  porous  good  woolen  socks  that 
do  not  fit  too  tightly. 

Linen  possesses  the  great  advantage  that  it  easily  absorbs 
moisture  and  easily  gives  it  off  again,  but  as  it  is  not  such  a  bad 
conductor  of  heat  as  wool,  and  freely  gives  off  heat,  it  may  most 
advantageously  be  utilized  in  warm  weather,  and  also  in  winter 
if  worn  under  the  other  woolen  garments. 

Linen  is  superior  to  wool  in  so  far  as  the  matter  of  cleaning 
it  is  concerned,  as  it  can  be  washed  much  more  thoroughly  than 
wool,  which  easily  retains  dust  and  dirt.  Linen  is  one  of  the 
most  porous  substances  for  underwear. 

Ramie  is  a  material  made  from  a  tropical  plant,  the  Ba?h- 
meria  Nivea,  and  has  lately  come  much  into  use.  It  readily 
absorbs  the  moisture  from  the  skin  and  does  not  retain  it  as 
long  as  does  wool,  but  rapidly  gives  it  off  again.  It  also  does 
not  abstract  warmth  so  much  as  linen,  and  next  to  wool  is  the 
warmest  material  for  underwear.  The  drawbacks  to  it,  how- 
ever, are  that  it  is  too  heavy  and  does  not  last  long.  Silk  under- 
wear also  retains  the  warmth,  and  also  very  easily  absorbs 
moisture;  but  it  is  too  expensive  for  ordinary  use,  and  can 
readily  be  spoilt  by  indifferent  washing,  unless  the  most  expen- 
sive quality  is  used. 

Of  all  the  various  materials  for  use  as  underwear  possibly 
cotton  has  the  greatest  average  advantages.  It  gives  off  the 
moisture  it  has  absorbed  from  the  skin,  although  not  quite  so 
efficaciously  as  does  linen.  According  to  James  Paton  it  absorbs 
moisture  equally  well  as  linen;  but  Pettenkoffer  is  of  a  dif- 
ferent opinion,  as  in  his  view  cotton  does  not  absorb  the  moisture 
from  the  skin  as  readily  as  does  linen. 

The  greatest  advantage,  however,  of  cotton  over  all  other 
kinds  of  material  (except  perhaps  ramie)   for  underwear  is  its 


222  Old  Age  Deferred. 


porosity.  It  is  about  the  most  porous  material  there  is,  espe- 
cially if  in  the  course  of  manufacture  the  maker  takes  particular 
care  in  selecting  the  very  best  cotton;  it  does  not  shrink  like 
wool,  and  therefore  does  not  lose  its  porosity  in  the  same  way 
when  washed. 

When  cotton  is  so  manufactured  as  to  present  the  greatest 
possible  porosity,  it  has  also  the  great  advantage  of  being  almost 
as  warm  as  wool,  which  is  due  to  the  fact  that  air  can  enter 
freely  everywhere  and  remain  in  the  interstices  of  the  material. 
It  has  already  been  mentioned  that  air  is  a  bad  conductor  of 
heat,  so  that  cotton  underwear  of  good  quality  retains  the 
warmth  of  the  body  and  at  the  same  time  allows  a  free  exit  for 
the  exhalations  of  the  skin.  If,  therefore,  cotton  be  prepared 
from  the  best  possible  material,  and  manufactured  in  such  a 
manner  as  to  obtain  the  greatest  amount  of  porosity,  i.e.,  when 
it  is  loosely  woven,  it  can  compete  successfully  with  wool  as 
material  for  warm  underwear ;  it  is,  therefore,  quite  an  erroneous 
view  to  hold,  as  so  many  do,  that  cotton  is  very  different  in  this 
respect  from  wool ;  everything  depends  upon  the  quality  and  the 
manner  in  which  it  is  manufactured. 

According  to  the  researches  of  Sir  William  Thompson1 
there  is  practically  no  difference  between  wool,  cotton,  and  linen 
in  regard  to  their  capacity  as  conductors  of  heat.  Nevertheless 
we  ourselves  still  believe  that  in  winter  weather,  or  when  there 
are  cold  northern  winds,  wool  is  best,  especially  for  the  aged. 
This  same  holds  good  also  for  those  younger  persons  who  catch 
cold  easily. 

In  order  to  keep  warm  in  winter  it  is,  however,  necessary 
that  the  cotton  material  should  be  of  a  certain  thickness,  besides 
being  of  the  best  quality  and  of  the  best  make.  As  already  men- 
tioned it  is  of  the  utmost  importance  that  the  underwear  should 
not  fit  too  closely  around  the  body,  but  that  there  should  always 
be  a  layer  of  warm  air  between  the  skin  and  the  garment.  In- 
stead of  the  present  custom  of  wearing  close-fitting  trousers  it 

1  Sir  William  Thompson,  in  "Heat,"  Encyclopaedia  Britannica. 


On  Rational  Clothing.  223 

would  be  much  more  beneficial  to  adopt  the  very  large  loose 
linen  trousers  that  are  worn  in  certain  countries,  such  as  Hun- 
gary. When  once  accustomed  to  such,  and  especially  in  the 
case  of  the  younger  generation,  they  can  readily  be  worn  also  in 
winter  time.  Then,  possibly,  porous  cotton  can  take  the  place 
of  linen,  although  many  people  may  feel  just  as  warm  in  porous 
linen  underwear ;  or  we  could  possibly  follow  the  example  of  an 
English  gentleman  who  told  me  he  never  wore  any  underdrawers 
at  all. 

In  many  European  countries  women,  especially  of  the  lower 
classes,  wear  no  undergarments  on  their  legs  at  all.  In  healthy 
women  such  a  custom  may  be  of  great  advantage,  as  it  permits 
of  the  free  passage  of  air  and  the  elimination  of  the  perspiration 
from  the  skin,  being  in  effect  a  continuous  free  air  bath  for  the 
lower  parts  of  the  body. 

It  is  not  so  necessary  to  keep  the  lower  extremities,  except 
the  feet,  warm  (provided  that  the  feet  are  made  warm  by  the 
constant  motion  of  their  muscles),  as  we  do  not  need  to  be  so 
well  protected  there  as  on  the  upper  parts  of  the  body;  we  also 
feel  the  cold  less  in  these  parts,  which  we  can  all  appreciate  if 
we  are  in  the  habit  of  walking  much  and  not  sitting  about  all 
day. 

Before  putting  on  clean  underwear  we  must  be  careful  to 
ascertain  that  it  has  been  thoroughly  aired  and  is  quite  dry,  for 
it  happens  in  more  cases  than  one  knows  of  that  the  linen  arrives 
from  the  laundry  quite  damp,  although  apparently  it  appears 
and  feels  dry.  After  having  caught  cold  each  time  I  changed 
my  linen,  after  having  perspired,  I  had  the  idea  to  put  my  vest 
over  an  electric  lamp,  and  was  surprised  to  see  a  cloud  of  mois- 
ture arise  from  it.  As  moisture  readily  absorbs  the  warmth  of 
the  body,  we  can  therefore  easily  lose  too  much  warmth  and 
thus  catch  cold.  Before  putting  on  clean  linen  it  is  also  advis- 
able to  rub  the  body  with  a  brush  (or  rough  towel)  until  the 
skin  glows,  and  the  linen  itself  should  of  course  be  put  into  a 
hot-air  cupboard  or  be  aired  before  a  stove  or  fire,  by  which 


224  Old  Age  Deferred. 


means  many  colds  will  be  prevented;  and  these  precautions  are 
particularly  necessary  in  all  cases  after  free  perspiration,  in 
which  latter  case  also  a  bath  is  very  desirable  before  putting  on 
our  clean  linen.  It  is  of  primary  importance  to  change  under- 
wear every  day,  so  as  not  to  leave  the  products  of  perspiration 
on  the  skin  for  several  days  (see  chapters  on  the  hygiene  of 
the  skin  and  kidneys  through  perspiration). 

We  will  now  offer  a  few  remarks  on  the  subject  of  white 
linen.  We  should  not  wear  starched  linen  shirts,  as  they  are  less 
permeable  to  the  air.  In  lieu  of  these,  porous  linen  shirts  are 
advisable,  or  any  other  kind  of  soft  and  porous  material,  without 
a  starched  front.  The  use  of  starched  shirts  should  be  confined 
to  dinner  parties  and  social  functions. 

The  most  absurd  part  of  our  linen  outfit  is  unquestionably 
that  instrument  of  torture  we  wear  as  a  yoke  around  our  neck, 
preventing  a  free  circulation  through  our  most  important  arteries 
and  throttling  one  of  our  most  important  organs — the  thyroid 
gland.  This  we  know  as  the  "starched  collar,"  without  which 
we  must  not  appear  in  decent  society.  It  is  in  any  or  all  of  its 
present  shapes  an  unhealthy  article  of  clothing,  but  especially  so 
when,  from  foolishness,  it  is  worn  standing  high  up  to  the  chin, 
keeping  away  the  air  from  the  neck  and  hindering  free  cir- 
culation. Its  bad  effects  upon  the  thyroid  have  already  been 
referred  to  in  the  chapter  on  the  hygiene  of  the  thyroid  gland. 
It  would  be  more  reasonable  to  wear  a  low  collar,  turned  down, 
and  of  soft  linen,  as  worn  by  our  forefathers.  Women  may  have 
this  privilege,  but,  sad  to  say,  they  do  not  avail  themselves  of 
it,  but  instead,  in  many  instances,  cover  their  necks,  and  even  more 
than  their  neck,  by  impermeable  materials.  Yet  the  neck  is  one 
of  the  parts  of  the  human  frame  where  many  sudorific  glands  are 
situated  and  where  we  perspire  freely.  These  parts  especially 
should  not  be  enclosed  by  clothing;  neither  should  the  arm- 
pits and  the  toes  of  the  feet,  for  here  the  sudorific  glands  of  the 
body  are  very  numerous.  Yet  we  wear  the  most  impermeable 
materials,  such  as  leather,  and  often  indeed  thick  leather,  and 


On  Rational  Clothing.  225 

horribile  dictu!  even  rubbers,  very  often,  on  these  important 
organs. 

The  outer  garments  should  also  be  made,  after  careful  con- 
sideration, to  afford  the  greatest  amount  of  porosity.  It  would 
be  the  height  of  hygienic  triumph  to  wear  clothes  made  to  allow 
of  the  free  inlet  of  wholesome  sunlight.  Gray  garments  are, 
therefore,  the  best,  and  next  to  this  blue  should  be  greatly  pre- 
ferred to  dark  colors. 

The  overcoat  should  never  be  too  heavy  nor  too  warm; 
as  a  general  rule,  we  should  never  wear  clothes  warmer  than  the 
temperature  at  the  time  requires,  always  being  guided  by  the 
thermometer  and  not  by  the  calendar.  It  is  much  better  to  be 
clad  too  lightly  than  too  warmly,  for  we  thus  avoid  perspiring 
and  thereby  catching  cold;  or,  in  other  words,  if  clad  simply 
lightly  the  likelihood  of  our  taking  cold  is  less  than  when  we 
are  too  warmly  clothed,  for  then  we  also  perspire  less  freely. 
It  may  be  that  we  shall  more  readily  feel  cold,  but,  fortu- 
nately, the  sensation  of  feeling  cold  does  not  imply  catching  cold. 
In  fact,  when  lightly  clad  we  feel  much  more  inclined  to  take 
brisk  exercise.  Then  we  feel  warm,  and,  as  we  shall  show  in  the 
chapter  on  exercise,  more  blood  is  sent  to  the  periphery  of  the 
body  and  the  general  nutrition  of  the  skin  is  increased. 
Naturally,  when  we  are  lightly  clad  we  do  not  sit  about  without 
moving,  but  we  endeavor  to  create  a  reaction  in  the  skin  by  brisk 
exercise.  Englishmen,  and  especially  Scotchmen,  rarely  wear 
an  overcoat,  never  sleep  in  a  warmed  room,  and  rarely  ever  catch 
cold,  which  is  certainly  much  more  prevalent  in  countries  with 
overheated  houses,  as  in  America,  and  where  the  people  are  more 
accustomed  to  ride  in  the  street  cars  (also  heated)  than  to  walk. 

Catching  cold  is  best  obviated  by  hardening  the  body  against 
the  influence  of  cold,  and  this  is  best  done  by  a  continual 
aeration  of  the  skin,  and  by  means  of  cold  baths,  commenced  in 
a  judicious  manner.  We  should  become  accustomed  to  permit 
the  entrance  of  air  as  frequently  as  possible  to  the  whole  sur- 
face of  the  body,  which  we  can  do  by  remaining  stark  naked  in 


226  Old  Age  Deferred. 


our  room  for  only  a  few  moments  several  times  a  day,  as  already 
advocated  in  the  chapter  on  the  hygiene  of  the  skin.  But  still 
more  important  is  free  access  to  the  air,  even  though  cold,  if  we 
desire  to  be  immune  against  colds.  Most  people  who  do  catch 
cold  contract  it  first  in  the  head,  especially  after  being  in  a  state 
of  perspiration. 

The  frontal  and  temporal  parts  of  the  head  are  very  well 
provided  with  sudorific  glands,  and  it  is  therefore  most  unreason- 
able to  prevent  free  air  access  by  a  warm  covering.  It  is  also 
unnecessary,  because  Nature  has  already  provided  these  parts 
with  a  natural  covering,  viz. :  the  hair,  which,  with  the  skull, 
is  intended  for  the  adequate  protection  of  our  most  delicate  organ, 
the  special  construction  of  which  places  us  above  all  other 
animal  creation. 

That  young  men  with  abundance  of  hair  should  wear  heavy 
head  coverings  is  extremely  unreasonable.  It  would  be  a  far 
more  healthy  custom  to  go  without  a  hat,  and  thus  preserve  for  a 
much  longer  period  this  natural  ornament  to  the  head.  At  the 
same  time  we  would  perspire  less  in  the  head  and  thus  be  less 
liable  to  take  cold.  By  continuing  this  practice,  as  is  customary 
among  the  boys  of  a  certain  English  school  (The  Blue  Coat 
School),  the  scalp  of  the  head  will  become  so  much  hardened 
against  climatic  influences  that  we  should  be  able  to  go  out  with 
uncovered  head  even  in  cold  weather.  As,  however,  not  all  our 
neighbors  and  acquaintance  are  keenly  interested  in  the  postu- 
lates of  health  and  long  life  they  may  laugh  at  first,  but  afterward 
they  will  themselves  be  converted  by  the  advantages  of  such  a 
custom  and  will  follow  our  example. 

Those  whose  scalp  has  become  bald  or  only  scantily  covered 
with  hair,  by  excluding  from  the  same  too  much  air  or  by  reason 
of  disease,  may  not  so  readily  stand  the  effect  of  the  cold, 
and  for  such  a  head  gear  may  be  necessary,  in  which  case  the 
preference  should  be  given  to  soft  and  very  light  felt  hats,  and 
not  to  those  made  of  hard  material,  which  prevent  the  circulation 
of  the  blood  through  the  scalp  and  thus  kill  the  roots  of  the  hair. 


On  Rational  Clothing.  227 

Those  who  are  slaves  to  the  prejudices  of  their  short-sighted 
brethren  may  wear  their  hat  when  in  their  company  or  in  the 
streets,  but  by  all  means  take  it  off  at  other  times,  and  especially 
when  in  the  woods  or  in  the  fields. 

It  is  a  singular  anomaly  that  the  English,  who  in  many  ques- 
tions of  hygiene,  as  by  conducting  their  sports  in  the  open 
air,  stand  at  the  head  of  all  nations,  yet  obstinately  stick  to  their 
tall  hats  and  long  black  coats  in  the  warmest  summer  weather, 
sacrificing  health  and  comfort  to  social  prejudices.  How  long 
will  Bacon's  nation  persist  in  such  a  custom  ?* 

Other  parts  of  the  body  richly  provided  with  sudorific 
glands  are  the  feet.  This  must  logically  make  it  obligatory  for 
all  who  wish  strictly  to  follow  the  rules  of  health  and  long  life 
not  to  prevent  the  free  access  of  air  by  impermeable  rubbers  or 
heavy  high  boots.  Leather,  of  course,  is  not  a  porous  material, 
like  certain  kinds  of  cloth,  and  hinders  the  free  passage  of  air 
and  the  evaporation  from  the  surface  of  the  feet.  The  most  suit- 
able footwear,  and  that  best  adapted  to  the  demands  of  rational 
hygiene,  would  be  sandals,  similar  to  those  worn  by  the  Greeks 
and  the  Romans.  Such,  however,  could  only,  in  present  days, 
be  worn  in  villages,  at  the  seaside,  or  in  the  country  generally, 
if  we  do  not  want  to  be  criticized  as  queer  or  eccentric  by  our 
neighbors,  who  have  less  knowledge  of  the  hygienic  methods  of 
living. 

It  might  be  possible  to  make  footwear  in  such  a  manner  as 
to  overcome  this  feeling  as  to  wearing  them — of  the  nature  of 
sandals,  or  part  sandals  and  part  shoes — such  as  slippers  or 
"pumps."  At  any  rate  it  is  advisable  never  to  wear  other  foot- 
gear than  half-shoes,  and  the  author  of  this  work  wears  such  even 
in  winter  time  without  inconvenience  and  without  feeling  cold. 
The  best  half-shoes  for  summer  wear  would  be  those  made  of 
canvas  with  leather  soles.  It  goes  without  saying  that  one  has  to 
get  accustomed  to  this  habit  of  wearing  low  shoes,  by  beginning 


*  Latterly  city  men  wear  straw  hats  in  summer  and  also  the  coachmen 
and  servants  of  the  upper  class. 


228  Old  Age  Deferred. 


in  warm  weather  and  continuing  uninterruptedly  to  the  winter, 
and  even  throughout  that  season,  unless  very  severe  weather 
prevails,  when  gaiters  should  be  worn  above  them. 

If  porous  woolen  socks  of  the  best  quality  are  worn  in  con- 
junction with  the  half-shoes  cold  is  not  felt,  especially  if  we  do 
not  remain  still  but  walk  about  briskly,  which  will  practically 
convince  us  of  the  necessity  of  walking  and  running  for  exercise. 

Rubbers  are  unquestionably  unhealthy  things  to  wear,  and 
to  many  will  cause  a  disagreeable  sensation  owing  to  the  hindrance 
to  foot  perspiration. 

It  is  advisable  to  take  off  our  shoes?  as  the  Mohammedan 
does,  as  often  as  possible  during  the  day;  for  instance,  while 
working  or  reading,  and  at  any  time  when  we  are  in  private, 
and  only  put  them  on  again  when  visitors  are  present.  Every- 
body appreciates  what  an  agreeable  sensation  it  is  to  take  off  one's 
shoes  and  have  a  good  airing  of  the  feet,  especially  after  a 
long  walk,  in  which  latter  case  a  foot-bath  is  also  a  capital 
thing  which  will  certainly  increase  our  comfort,  especially  if  we 
have  been  wearing  sandals  or  half-shoes  and  we  have  been  wan- 
dering about  the  country  exposed  to  dust. 

We  have  referred  more  fully  to  the  use  of  the  foot-bath 
in  another  chapter.  In  the  same  way  as  with  our  foot-wear,  we 
should  reform  our  ways  by  removing  the  yoke  which  cruel 
fashion  obliges  us  to  wear  round  our  necks — the  high,  stiff  col- 
lar. How  long  shall  we  continue  to  put  up  with  these  con- 
tinuous impediments  to  our  health?  Top  hats!  tight  collars! 
tight  boots  with  a  pointed  toe!  and  a  fur  coat  over  our  dark 
clothes!  How  can  the  sun  and  air  penetrate  such  idiotic  har- 
ness, and  how  can  the  poisonous  exhalations  of  the  body  find 
their  way  into  the  fresh  air  when  they  are  retarded  by  very 
heavy  and  warm  woolen  underwear?  We  must  again  repeat 
that  we  catch  cold  much  more  easily  when  we  are  clad  too 
warmly  than  too  lightly.  The  more  freely  we  perspire  in  our 
clothes  the  more  easily  we  catch  cold.  We  found  this  from 
personal  experience.    We  were  at  one  time  always  catching  cold, 


On  Rational  Clothing.  229 

in  consequence  of  too  sedulously  wrapping  ourself  in  woolen 
garments  and  heavy  clothing.  But  since  we  have  taken  to  wear- 
ing linen  or  cotton  underwear  and  light  clothes,  with  half-shoes, 
carrying  our  hat  in  the  hand,  and  the  overcoat  rather  on  the  arm 
than  on  the  body,  we  now  rarely  ever  catch  cold. 

All  of  our  garments  should  be  loosely  fitting,  and  in  this 
respect  the  American  fashion  for  men's  clothing  is  superior  to 
the  European  fashion  of  tightly  fitting  garments.  Also  the 
present  style  of  long,  narrow  trousers  is  not  only  unassthetic  but 
also  unhealthy  and  unsuitable  for  quick  movements.  Let  us 
go  back  to  the  knee-breeches  of  forefathers,  who  were  thereby 
made  much  more  pleasing  to  the  eyes — at  least,  those  of  normal 
build  were. 

A  sufficient  aeration  of  the  body  is  necessary  not  only  by 
day,  but  by  night.  In  fact,  it  is  more  necessary  at  night,  for 
as  mentioned  in  the  chapter  on  sleep,  the  ridding  of  the  body 
from  toxic  products  is  performed  more  actively  during  the  night. 
It  will  logically  follow  from  this  consideration  that  heavy  feather 
beds  and,  in  fact,  all  kinds  of  heavy  coverlets  are  not  beneficial 
to  health,  as  they  are  apt  to  suppress  the  exhalations  of  the  body 
and  to  prevent  the  access  of  air  to  the  body.  For  the  same  rea- 
sons it  is  also1  imprudent  to  go  to  bed  in  underwear,  and  par- 
ticularly if  woolen.  I  would  even  go  so  far  as  to  dispense  with 
the  use  of  the  night-shirt,  a  garment  which  was  quite  unknown 
to  our  ancestors  until  a  few  hundred  years  ago.  By  going  to  bed 
quite  nude,  in  a  large  bed,  with  ample  bed  clothes  of  a  porous 
material  wrapped  not  too  tightly  about  the  body,  we  have  thus  a 
kind  of  air-bath  in  bed  and  feel  more  refreshed  in  the  morning, 
especially  after  having  slept  in  a  room  where  the  air  can  enter 
freely.  In  cold  weather  in  winter  a  double  woolen  coverlet  can 
be  used. 

It  may  be  that  in  carrying  out  strictly  the  rules  of  a  rational 
hygiene  of  clothing  as  laid  down  above,  many  people  may  have 
to  revolutionize  their  old  habits  of  an  unhealthy  and  life-short- 
ening way  of  living.    But  the  real  question  is :    Do  we  want  to 


230  Old  Age  Deferred. 


live  long  and  retain  as  long  as  possible  our  youth  that  is  passing 
away  only  too  quickly  in  any  case,  or  do  we  want  to  descend 
into  an  early  grave  before  our  time?  Those  who  desire  the  first 
alternative  and  who  wish  to  enjoy  their  lives  up  to  the  very  last 
may  follow  my  advice ;  then  they  will  soon  be  rewarded  by  fresher 
looks  and  increased  vital  power. 


CHAPTER  XXVI. 

Improved  Hygiene  of  the  Skin  and  Kidneys  through 
Bathing — Foot-baths. 

Every  day  we  are  getting  rid  of  the  superficial  layers  of 
the  skin,  which  process  can  become  so  intense  in  some  people 
that  the  skin  looks  as  though  it  were  covered  with  flour  dust; 
and  in  some  persons  with  dry  skin  such  apparel  as  stockings 
sometimes  gets  full  of  this.  These  minute  scales,  which  get 
necrotised  in  the  upper  parts  of  the  skin,  are  apt  to  clog  the 
pores,  which  can  also  become  closed  by  particles  of  dust,  or  by 
products  of  the  sebaceous  glands  and  by  perspiratory  residues. 
As  the  free  entrance  of  air  to  the  pores  is  an  essential  condition 
for  skin  respiration,  and  as  the  elimination  of  harmful  products 
is  only  possible  when  the  pores  remain  open,  we  must  get  rid 
of  the  foreign  matters  which  clog  them,  for  which  purpose  we 
take  a  bath.  But  water  alone,  even  if  it  be  hot,  is  not  able  to 
effect  a  thorough  cleansing  of  the  skin  on  account  of  the  oily  sub- 
stance which  is  secreted  by  the  sebaceous  glands ;  so,  to  obtain  the 
fullest  cleansing  effects,  we  add  the  use  of  soap  and  a  brush,  as 
already  mentioned  before.  We  must  rub  the  soap  well  in,  and 
then  rub  it  off  energetically,  if  we  desire  to  benefit  by  a  fully 
hygienic  bath. 

As  we  are  daily  getting  rid  of  the  above-mentioned  skin 
scales,  so  it  behooves  us  to  take  a  daily  bath.  It  is  not  necessary 
to  stay  in  the  bath  more  than  ten  to  twelve  minutes,  or  at  the 
most  fifteen.  For  the  reasons  above  mentioned  the  effect  of 
bathing  is  a  rational  hygiene  of  the  skin. 

By  the  action  of  the  water,  soap,  and  brush  friction  the 
skin  receives  more  blood,  which  is,  at  the  same  time,  a  great 
advantage  to  the  internal  organs,  as  the  blood  drawn  away  from 
them  facilitates  the  circulation  through  them   should  they  be 

(231)   ' 


232  Old  Age  Deferred. 


congested.  When  more  blood  reaches  the  skin  the  muscles  that 
contract  the  pores  are  also  better  nourished,  and  they  then  react 
better  to  certain  agencies — cold,  for  instance.  They  quickly 
contract  the  pores,  so  that  the  blood  will  be  kept  back  in  the 
interior  of  the  body  and  a  cooling  off  of  the  periphery  of  the 
body,  with  its  dangerous  consequences  from  catching  cold,  may 
thus  be  avoided. 

A  daily  bath  can  also  be  advantageous  for  those  who  per- 
spire too  freely.  After  a  bath,  and  this  is  one  of  its  greatest 
advantages,  the  insensible  perspiration  is  much  increased,  and 
more  water  leaves  the  body  through  the  pores  than  before,  and 
when  a  bath  has  been  too  hot,  a  very  free  perspiration  may 
ensue.  But  usually  with  people  with  a  too  free  perspiration, 
this  tendency  would  be  diminished,  as  it  can  often  be  noted  that 
those  who  daily  take  a  luke-warm  bath  perspire  less  than  others 
on  warm  summer  days. 

Besides  exciting  the  functions  of  the  skin  baths  are  also  an 
excellent  means  for  diminishing  a  possible  overwork  of  the  kid- 
neys, and  thus  keeping  them  in  good  condition.  It  is  possible  to 
eliminate,  through  bathing,  such  products  by  the  skin  which 
otherwise  would  have  to  be  eliminated  through  the  kidneys. 

It  has  recently  been  shown  by  experiments  conducted  by 
Strasser  and  Blumenkranz1  that  baths  taken  for  a  long  time  and 
at  a  temperature  of  34-3  50  C,  are  able  to  create  an  increased 
elimination,  not  only  of  a  considerable  quantity  of  water,  but  of 
common  salt  also,  and  of  the  products  of  decomposition  of 
nitrogenous  matter. 

These  authorities  come  to  the  conclusion  that  through  bath- 
ing there  can  be  brought  about  a  true  increase  not  only  of  the 
water-secreting  activity  of  the  kidneys,  but  also  of  their  ability  to 
eliminate  nitrogenous  end-products  and  salt.  They  found  an 
increase  of  diuresis  to  double  the  usual  amount  and  an  increased 
elimination  of  from  50  to  100  per  cent,  of  nitrogen,  and  from  100 


l  Strasser  und  Blumenkranz :      "Die  Wirkung  indifferenter  und  schweiss- 
tresbender  Bader  bei  Nephritis,"  Med.  klin.,  Beichfte  Hefte  6,  1907. 


Bathing — Foot-baths.  233 


to  200  per  cent,  of  salt.  According  to  Liebermeister,  Loevvy, 
Rubner,  and  others,  the  processes  of  oxidation  can  be  increased 
by  cold  baths  from  50  or  100  to  200  per  cent.,  and  by  hot  baths, 
according  to  Winternitz  and  Rubner,  50  to  100  per  cent.  Rubner 
also  asserts  that  the  processes  of  oxidation  can  be  wonderfully 
increased  by  cold  douches. 

There  can  thus  be  no  doubt  that  baths  are  able  to  influence 
the  conditions  of  the  kidneys  in  a  very  favorable  way,  and  that 
their  vitality  may  be  augmented  by  the  daily  use  of  the  bath. 

The  drawback  to  the  bath  is  that  so  many  people  easily 
catch  cold  afterward ;  to  prevent  which,  such  persons  should  not 
wet  the  head,  and  especially  the  back  part  of  it,  as  otherwise 
catching  cold  is  easily  effected ;  and  it  is  also  of  importance  that 
the  bath-room  should  not  be  left  while  the  skin  is  hot.  The 
best  way  is  to  allow  cold  water  gradually  to  enter  the  bath, 
getting  out  directly  there  is  the  least  sensation  of  cold.  The 
rule  should  be  not  to  leave  the  bath  when  the  skin  is  hot  and 
red  and  the  pores  wide  open,  without  letting  cold  water  contract 
them  by  taking  a  short  douche,  and  on  getting  out  of  the  bath 
the  skin  should  be  quickly  dried  by  energetic  friction  with  a 
rough  towel  until  the  skin  becomes  quite  scarlet.  Not  sufficiently 
drying  the  skin  will  cool  it  rapidly,  and  even  intensely,  owing  to 
the  evaporation  of  the  water  from  the  periphery,  and  surely  cause 
a  severe  cold. 

To  prevent  the  habit  of  catching  cold  the  best  way  is  to 
accustom  the  skin  to  the  action  of  cold  water.  Rubbing  the  skin 
with  a  cold  wet  towel  until  the  skin  glows,  especially  the  chest 
and  extremities,  is  a  good  way  to  effect  this,  beginning  in  warm 
summer  weather  and  continuing  through  the  winter,  but  not 
vice  versa.  Decidedly  the  best  preventative  to  catching  cold  is 
to  get  the  skin  accustomed  to  fresh  air  and  cold  water. 

To  prevent  catching  cold  after  a  bath  a  reaction  of  the  skin 
is  necessary,  and  this  is  best  attained  by  a  rough  towel,  as  before 
mentioned,  and  by  rubbing  the  body  with  a  hard  brush.  Mas- 
sage is  an  excellent  addition  to  bathing,  as  by  this  means  the 


234  Old  Age  Deferred. 


circulation  through  the  skin  and  muscles  is  much  increased,  there- 
by increasing  the  oxidation  of  the  body.  By  kneading  the 
muscles  waste  products  are  brought  into  the  lymphatics  (see,  also, 
chapters  on  exercise). 

It  is  only  logical  that  we  must  pay  special  attention  to 
cleanliness  in  those  parts  that  have  the  greatest  number  of 
sudorific  glands,  such  as  for  example  the  axillae  and  the  toes  of 
the  feet.  Circumstances  often,  as  when  on  a  journey,  do  not 
allow  of  the  luxury  of  a  complete  bath,  and  in  such  cases  we  must 
be  content  to  wash  the  body  with  water  and  soap,  and  to  rub 
down  with  a  rough  towel  and  brush,  paying  particular  attention 
to  the  axillae  and  feet.  These  may  also  be  bathed  in  alcohol  and 
water,  1/2  to  1/3  of  the  latter,  and  also  with  vinegar  and  water; 
the  feet  can  best  be  cleansed  in  a  foot-bath. 

From  ancient  times,  especially  in  the  East,  such  foot-baths 
have  been  largely  used,  probably  for  the  reason  that  sandals  were 
worn,  which  allowed  dust  and  dirt  to  accumulate  on  the  feet; 
people  whose  feet  perspire  freely  should  always  use  a  foot-bath 
daily ;  and,  because  the  feet  are  a  part  of  the  body  which  are  the 
worst  aerated  from  being  covered  with  impermeable  leather,  while 
they  are,  at  the  same  time,  the  best  provided  with  sudorific  glands, 
a  daily  foot-bath  is  advised  for  all. 

When  the  feet  perspire  freely,  hot  water  must  be  used;  but 
after  using  such  we  must  immediately  use  cold  water  so  that  the 
opened  pores  will  close  again.  Pouring  cold  water  into  the  bath 
or  over  the  feet  will  effect  this,  but  it  must  be  done  quickly. 

Foot-baths  are  excellent  things  for  those  who  suffer  from  ' 
cold  feet,  and  what  at  first  sight  seems  paradoxical,  a  cold  foot- 
bath in  particular,  which  acts  by  enlivening  the  circulation  in 
the  feet;  the  bathing  should,  however,  only  last  about  a  couple 
of  minutes.  Cold  baths  for  the  feet  also  act  very  beneficially 
in  cases  of  headache,  and  especially  in  insomnia.  They  act  upon 
the  distribution  of  blood  in  the  brain;  the  blood-vessels  are 
thereby  first  distended  and  afterward  they  contract,  which,  last- 
ing for  a  certain  time,  induces  sleep;  for,  as  mentioned  in  the 


Bathing— Foot-baths.  235 

chapter  on  sleep,  the  brain  must  be  free  from  blood  if  sleep  is 
to  result.  In  hot  summer  weather  it  is  quite  delightful  to  sit  on 
the  banks  of  a  river  and  allow  our  feet  to  dangle  in  the  water, 
and  we  always  feel  refreshed  after  it;  walking  with  bare  feet 
is  also  very  pleasant  and  healthy  in  summer  time. 

The  action  of  a  foot-bath  is  much  increased  by  the  addition 
of  salt  or  mustard,  and  with  the  latter  is  an  excellent  preventa- 
tive against  a  hyperaemic  condition  of  the  brain,  such  as  apo- 
plexy, as  thereby  we  favor  a  decreased  congestion  of  this  noble 
organ. 

Cold  foot-baths  should  not  be  used  by  very  old  people,  as 
they  distend  the  brain-vessels  which,  as  a  rule,  are  altered  in 
such  people  and  may  more  easily  rupture;  if  taken,  a  wet,  cold 
towel  should  be  wound  round  the  head. 

Cold  baths  generally  are  often  beneficial  in  the  case  of  cer- 
tain nervous  troubles,  such  as  neurasthenia  and  hysteria;  only 
they  must  never  be  too  cold  nor  too  prolonged,  as  otherwise  the 
effects  may  be  very  depressing.  A  short  cold  friction  of  the 
body  every  morning  on  rising  is  of  great  advantage  in  the  pre- 
servation of  health.  In  kidney  trouble  we  must,  however,  be 
careful,  as  often  an  increase  of  albuminuria  has  been  observed 
after  them.  Sea  baths  are  especially  refreshing,  owing  to  the 
sodium  content  of  the  salt  water.  Our  own  observations  teach 
us  that  a  bath  had  best  be  taken  by  first  using  water  of  the  highest 
temperature  that  can  be  borne  (about  42  degrees  C).  Those 
who  can  stand  it  might  continue  to  add  hot  water  until  the  skin 
is  quite  red.  Abundant  perspiration  will  then  appear  on  the  head, 
face,  and  neck.  After  having  perspired  freely,  we  should  then 
allow  cold  water  to  enter  until  the  bath  has  become  cool. 
It  usually  takes  some  time  to  cool  the  water  off  thus  gradually, 
but  after  such  a  bath  there  is  a  feeling  of  great  exhilaration, 
especially  after  warm  sea  baths  taken  in  this  manner.  We  con- 
sider that  hot  baths  of  long  duration — say  30  to  45  minutes — are 
especially  useful  in  cases  of  kidney  disease,  or  as  a  preventive  of 
such.    We  could  take  them  twice  a  week  as  a  means  of  eliminat- 


236  Old  Age  Deferred. 


ing  the  toxic  products  of  metabolism,  but  it  is  an  essential  condi- 
tion that  the  heart  and  blood-vessels  be  in  good  condition.  The 
Japanese  are  in  the  habit  of  taking  such  hot  baths  at  an  enor- 
mously high  temperature,  and  they  feel  the  better  for  it. 

Bathing  generally  is  favorable  not  only  to  the  kidneys,  but 
to  all  the  organs,  as  the  processes  of  oxidation  are  thereby  pro- 
moted, and  our  prospects  for  long  youth  and  long  life  are  bettered. 


CHAPTER  XXVII. 

Hygiene  of  the  Skin  and  Kidneys  by  Means  of 
Perspiratioi" 

Under  normal  conditions  we  daily  lose  a  certain  amount 
of  water  and  also  of  gaseous  and  solid  products,  among  them 
many  harmful  ones,  through  the  invisible  and  insensible  per- 
spiration of  the  skin.  That  such  a  process  does  actually  take 
place  is  proved  by  our  personal  observation  and  by  the  disagree- 
able feeling  produced  in  cold  and  damp  weather  by  the  checking 
of  such  perspiraton.  We  can  even  be  seriously  affected  if  by 
disease  or  by  extensive  burns  a  large  portion  of  the  skin  be 
destroyed,  thus  abolishing  this  insensible  perspiration. 

The  invisible  and  insensible  perspiration  can  become  visible 
and  sensible  when  either  its  evaporation  into  the  air  is  checked, 
as  in  the  case  of  tight-fitting  clothing,  such  as  a  rubber  over- 
coat, or  when  the  temperature  of  the  medium  around  the  body 
is  raised.  Both  conditions  can  be  fulfilled  by  fur  clothing,  for 
which  reason  its  use  as  wearing  apparel  is  to  be  deprecated. 

When  in  a  state  of  perspiration  we  should  take  special  care 
that  the  passage  of  the  perspiratory  products  into  the  air  shall 
not  be  impeded  by  any  means.  Fur  garments  are  not  so  un- 
suitable for  old  people  in  whom  the  perspiratory  functions  of  the 
skin  are  much  diminished.  We  have,  in  this  connection,  ob- 
served an  old  lady  of  j6  sitting  at  the  dinner  table,  close  to  an 
overheated  fireplace,  and  wearing  a  large  fur  collarette,  in  which 
she  felt  quite  comfortable.  As  frequently  mentioned  in  this  book, 
in  old  age  there  is  a  degeneration  of  the  thyroid  gland  to  a 
greater  or  lesser  degree,  and  consequently  a  lowering  of  the 
temperature  of  the  body  and  a  diminution  of  the  functions  of  the 

skin,  which  is  dry  and  rarely  perspires. 

(237) 


238  Old  Age  Deferred. 


When  the  temperature  of  the  medium  which  surrounds  the 
body  is  raised  to  a  high  degree,  the  capillaries  of  the  skin  are 
widened  and  more  blood  circulates  through  them;  thus  also 
more  blood  is  conveyed  to  the  sudorific  glands,  and  naturally 
more  water  is  then  excreted  by  them,  and  at  the  same  time  also 
more  of  the  solid  and  harmful  products.  According  to  Camerer, 
the  sweat  contains  in  each  ioo  grammes  50.6  g.  ashes,  10  g.  fat, 
and  10  g.  nitrogenous  matters,  of  which  30  per  cent,  is  urea  and 
75  per  cent,  is  ammonia.  Uric  acid  was  also  found  in  the  sweat 
of  healthy  people,  but  Magnus  Levy  found  it  missing  in  gouty 
patients.  By  frequent  sweating  procedures  the  hygienic  condi- 
tions of  the  skin  can  be  promoted,  and  especially  so  in  individuals 
whose  skin  is  generally  dry  and  inactive.  In  those  who  perspire 
much  too  freely,  however,  after  several  procedures  of  this  kind 
the  overactivity  of  the  sudorific  glands  can  be  diminished.  After 
very  free  perspiration  the  condition  of  the  skin  will  be  improved, 
and  then  we  will  note  the  disappearance  of  certain  skin  dis- 
eases, such  as  psoriasis  in  hot  summer  weather. 

Habitual  excessive  perspiration  can,  however,  impair  the 
skin  through  the  elimination  of  harmful  products,  although  the 
skin  is,  to  a  certain  extent,  protected  by  the  greasy  matters 
secreted  through  the  sebaceous  glands.  Likewise  we  can  also 
note  the  loss  of  hair  in  persons  perspiring  very  much  about  the 
head  and  more  particularly  in  those  parts  where  the  sudorific 
glands  are  situated,  such  as  the  forehead  and  temples.  This 
is  most  frequently  observed  in  those  who  have  dry  hair,  in 
whom  accordingly  there  is  a  diminution  of  the  functions  of  the 
sebaceous  glands.  In  persons  who  wear  fur  caps  and  whose 
head  is  always  covered,  we  most  frequently  find  bald  heads, 
especially  if  they  have  a  tendency  to  perspiring  about  the  head. 
For  this  reason  it  is  also  more  reasonable  never  to  wear  hats  if 
we  desire  to  retain  as  long  as  possible  the  natural  ornament  of 
the  head. 

We  can  cause  abundant  perspiration  by  all  the  various 
means  by  which  the  temperature  of  the  body  is  raised.     In  such 


Hygiene  of  the  Skin  and  Kidneys.  239 

cases  more  blood  comes  to  the  periphery  of  the  body,  and  thus 
also  to  the  sudorific  glands.  The  essential  factor  is  the  widening 
of  the  capillaries,  and  this  can  be  produced  not  only  by  agencies 
influencing  the  body  from  without,  such  as  hot  air  or  a  vapor 
bath,  but  also  by  agencies  from  within  the  body  which  act  on 
the  vasomotor  centers  and  thereby  cause  a  widening  of  the 
capillaries,  such  as  certain  drugs  like  salicylates,  and  also  organic 
preparations  like  thyroid  extracts ;  mental  emotion  will  also  cause 
such  an  occurrence.  Salicylates  are  excellent  drugs  for  produc- 
ing abundant  perspiration,  and  are  also  less  dangerous  than 
pilocarpine.  After  the  use  of  the  former  and  very  free  perspira- 
tion, we  notice  an  improvement  in  the  symptoms  of  gout,  for 
reasons  we  will  give  later. 

Of  the  different  baths  which  are  used  to  induce  perspiration 
we  award  the  preference  to  electric  light  baths,  where  we  obtain 
a  double  advantage,  for  we  can  unite  the  advantages  of  per- 
spiration with  those  of  the  influence  of  light  upon  the  body.  We 
are  able  to  prepare  such  a  bath  so  that  the  chemically  active  rays 
(see  chapter  on  the  advantages  of  sunshine)  are  obtained. 
Not  only  is  a  very  abundant  perspiration  produced  (indeed  some- 
times about  a  liter  of  sweat  can  be  removed  from  the  body  in 
from  twenty  to  twenty-two  minutes),  but  also  the  processes  of 
oxidation  can  be  augmented.  As  a  consequence  we  often  note 
a  great  diminution  of  fat  in  persons  with  a  superabundant  accu- 
mulation of  this  substance.  When  in  such  baths  blue  light  is 
used  and  the  blue  rays  are  acting  in  overwhelming  quan- 
tity, the  condition  of  the  nervous  system  can  be  influenced  in  a 
very  favorable  way,  and  especially  can  excited  conditions  be 
calmed.  It  is  also  probable  that  by  such  sweating  procedures 
toxic  products,  which  are  deleterious  to  the  nervous  system,  can 
be  removed.  Perspiration  can  also  be  caused  by  bodily  move- 
ment through  exercise.  In  such  cases,  as  proved  by  physiological 
experiments,  impulses  are  sent  to  the  vasomotor  centers,  which 
result  in  a  widening  of  the  capillaries  through  the  excitation  of 
such  centers.    Thus  sweating  is  created  by  fast  walking,  running, 


240  Old  Age  Deferred. 


and  frequently  also  by  horse-back  riding,  and  by  various  kinds  of 
sports,  such  as  cycling.  In  all  these  cases  it  is  essential,  however, 
to  change  the  clothes  and  underwear  which  we  have  worn  when 
perspiring,  and  to  take  a  bath;  for  the  possibility  is  not  to  be 
denied  that  a  part  of  the  toxic  products  which  adhere  to  the 
skin  after  such  sweating  exercises  may  be  re-absorbed,  although 
we  are  not  in  a  position  to  give  exact  experiments  to  prove  such 
a  supposition. 

Taking  a  bath  and  using  soap  and  brush,  and  creating  a 
friction  until  there  is  a  red  reaction  of  the  skin,  may  then  pre- 
vent the  danger  of  catching  cold,  but  after  such  a  bath  it  is  most 
important  not  to  leave  with  a  hot,  red  skin  and  opened  pores, 
but  to  cause  their  contraction  by  a  quick  cold  douche,  continued 
at  intervals  until  the  skin  is  cooled  and  the  pores  thereby  con- 
tracted. An  energetic  friction  of  the  skin  must  follow  before 
leaving  the  bathing  place. 

After  such  a  bath  we  shall  experience  a  sensation  of  great 
comfort,  and  shall  feel  much  lighter  and  fresher.  Such  baths 
should  be  taken  frequently,  at  least  once  a  week,  and  if  we  are 
very  desirous  of  keeping  a  youthful  appearance  for  a  long  time, 
even  more  frequently.  In  stout  people,  however,  it  is  necessary 
for  such  baths  that  the  muscles  of  the  heart  be  not  degener- 
ated; and  also  that  there  should  be  no  serious  affection  of  the 
heart  valves  or  of  the  blood-vessels,  if  baths  of  a  very  high 
temperature  and  lasting  a  considerable  time  are  indulged  in. 

In  cases  of  chronic  intoxication  and  such  like  diseases  of 
metabolism,  such  as  gout,  and  in  cases  of  old  age,  perspiration 
induced  by  very  hot  baths,  providing  the  circulatory  system  is  in 
good  condition,  should  be  tried  and  given  often  if  the  results 
prove  satisfactory,  as  we  thus  obtain  the  benefit  of  the  bath  and 
also  of  the  perspiration. 

The  sweat  baths  should  not  exceed  1 5  to  20  minutes  in  dura- 
tion unless  they  are  well  borne,  when  a  few  more  minutes  may  be 
added.  In  old  people  cold  douches  should  not  be  resorted  to, 
but  directly  after  the  bath  they  should  be  put  to  bed,  which  should 


Hygiene  of  the  Skin  and  Kidneys.  241 

have  been  previously  warmed  by  hot-water  bottles.  In  persons 
where  the  processes  of  oxidation  are  diminished  and  the  skin 
very  inactive,  as  is  the  case  with  many  aged  people,  such  baths 
give  very  excellent  results. 

Sweating  improves  the  functions  of  the  kidneys  in  a  much 
greater  degree  than  those  of  the  skin.  By  insensible  perspira- 
tion water  is  eliminated,  together  with  certain  harmful  solid 
products  which  otherwise  would  make  their  way  through  the 
kidneys;  this  occurs  much  more  so  when  the  perspiration  is 
greatly  increased  by  sweating  processes.  In  such  cases  about  a 
liter  of  water  can  pass  through  the  skin  daily,  and  in  addition  a 
considerable  part  of  the  nitrogenous  end-products  of  metabo- 
lism and  of  common  salt.  It  has  been  discovered  by  Professor 
Hermann  Strauss1  that  in  a  liter  of  sweat,  under  favorable  cir- 
cumstances, fully  six  grammes  of  common  salt  can  be  removed 
from  the  body.  Leube  once  found  2.31  grammes  of  chlorides  in 
800  grammes  of  sweat. 

Of  nitrogenous  bodies,  according  to  Strauss,  about  2 
grammes  can  be  removed  through  the  skin  daily,  and  according  to 
Professor  von.  Noorden2  only  1  gramme.  Leube  discovered, 
about  thirty  years  ago,  that  the  amount  of  nitrogen  in  the  urine 
was  2  grammes  less  on  such  days  as  sweating  processes  had 
been  used  than  was  usual  on  other  occasions.  Kovesi  and  Roth- 
Schulz  found  29  grammes  of  nitrogen  and  29  grammes  of  com- 
mon salt  in  the  sweat  of  patients  suffering  from  Bright's  disease. 
Strasser  and  Blumenkranz  found,  after  electric  light  baths,  a 
considerable  increase  in  the  elimination  of  common  salt  up  to  18 
grammes,  4  grammes  more  than  had  been  ingested.  Nitro- 
genous bodies  have  also  been  eliminated  in  larger  quantities  than 
have  been  introduced,  as  has  also  more  water.  This  has  been 
proved  in  experiments  on  the  effects  of  bathing,  in  which  people 
with  diseased  kidneys  have  oeen  used  as  the  subjects.  In  these 
cases  the  elimination  of  common  salt  and  nitrogenous  products  is 


1  Deutsche  Med.  Wochenschrift,  p.  34,  1904. 

2  v.  Noorden:     Pathologie  des  Stoffwechsel,  vol.  i,  1906. 

10 


242  Old  Age  Deferred. 


certainly  greater  than  in  normal  individuals.  Still  there  can  be 
no  doubt  that  with  such,  by  perspiration  and  bathing,  an  in- 
creased elimination  of  these  products  can  be  obtained. 

The  experiments  of  Roth-Schulz  and  Kovesi  are  most  in- 
teresting. These  authorities  discovered,  and  before  them  H. 
Strauss,  that  the  sudorific  glands  of  nephritic  patients  when  in 
increased  activity  can  secrete  a  liquid  that  is  more  concentrated 
than  the  blood.  Thus  a  compensatory  action  can  be  obtained. 
They  hold  that,  through  sweating,  from  10  to  20  per  cent,  of  the 
solids  in  the  urine  can  be  eliminated  through  the  skin. 

It  is  also  most  important  that  they  discovered  a  reduction 
in  the  molecular  concentration  of  the  blood,  which,  as  we  know, 
is  increased  in  nephritic  conditions.  The  frequency  of  sweating 
processes  for  persons  suffering  from  affections  of  the  kidneys  is 
all  the  more  indicated  because  such  persons,  generally,  have  a  pale 
and  very  dry  skin,  the  temperature  of  which  is,  as  a  rule,  dimin- 
ished. 

To  this  great  amelioration  of  the  kidney  functions  by  per- 
spiration is  also  due  the  fact  that  gouty  patients  are  much 
relieved  after  frequent  sweatings.  As  already  mentioned  we 
attribute  gout  to  an  alteration  of  the  tissues  of  the  kidneys,  by 
which  uric  acid  is  retained.  By  diverting  the  end-products  of 
the  nitrogenous  bodies  to  the  skin  and  relieving  the  kidneys  of 
a  part  of  this  strain,  we  may  also  improve  their  condition  and 
thereby  the  gouty  element.  At  the  same  time,  in  consequence  of 
these  procedures,  the  excretion  of  urine  has  much  increased; 
and  this  has  been  going  on  for  several  days,  not  only  after  the 
bath,  but  after  the  sweating.  By  such  an  increased  diuresis  the 
condition  of  gout  can  also  be  much  improved,  as  everything  that 
improves  the  kidneys  improves  that. 

From  the  observations  of  Haig,  the  elimination  of  uric  acid 
is  rendered  more  difficult  by  reason  of  the  presence  of  common 
salt;  the  increased  elimination,  therefore,  through  the  skin  must 
necessarily  be  more  advantageous  in. the  case  of  gouty  people. 

There  can  be  no  doubt  that  sweating  processes  are  of  great 


Hygiene  of  the  Skin  and  Kidneys.  243 

benefit,  not  only  to  the  kidneys,  but  also  to  the  other  organs, 
such  as  the  liver. 

We  also  generally  observe  perspiration  in  all  processes  of 
infection  or  intoxication,  and  it  may  therefore  be  regarded  as  a 
probable  species  of  self-defense  of  the  human  body  against  the 
attacks  of  microbes  or  other  toxic  products,  for  it  would  seem 
that  by  this  means  nature  desires  spontaneously  to  get  rid  of  the 
various  toxic  matters.  Indeed,  when  we  treat  fever  with  salic- 
ylates we  are  assisting  nature  to  this  end,  for  we  thus  create  per- 
spiration. As  already  mentioned  in  Chapter  III,  persons 
with  a  dry  skin,  who  perspire  but  rarely,  have  less  protection  from 
infectious  diseases  than  others.  Thus  everything  supports  the 
theory  that  the  various  toxic  products,  including  those  from 
microbes,  are  eliminated  by  perspiration.  Many  years  ago  we 
tried  to  find  microbes  in  the  sweat  of  typhoid  fever  patients  in  the 
St.  Pierre  Hospital  in  Brussels,  but  as  has  been  found  in  the 
bacteriological  laboratory  of  the  Institute  Solvay,  the  cultures 
that  formed  were  due  to  a  pollution  of  the  perspiratory  products 
with  foreign  microbes.  The  efforts  of  other  authorities  have 
also  failed  up  to  now  to  discover,  by  exact  research,  the  presence 
of  microbes  in  sweat,  as  expressive  of  their  elimination  through 
sweating.  But,  even  if  not  supported  by  exact  evidence,  we  feel 
inclined  to  believe  that  by  perspiration  in  abundance  a  number  of 
toxins  of  bacterial  origin  can  be  eliminated  from  the  blood,  be- 
cause in  feverish  ailments,  after  great  perspiration,  as  in  the  case 
of  pneumonia,  a  great  improvement  takes  place  in  the  condition  of 
the  patient.  In  former  times  bleeding  gave  similar  results,  per- 
haps in  a  greater  degree;  but  in  the  present  day  sweating  has 
superseded  this. 

To  the  hygiene  of  the  skin  through  bathing  we  would 
wish  to  add,  before  concluding  this  chapter,  that  carbonic  acid 
baths  may  also  give  good  results,  as  they  cause  a  better  circula- 
tion of  the  blood  through  the  skin,  which  gets  red.  Such  baths 
are  also  excellent  preventatives  against  arteriosclerosis. 


CHAPTER  XXVIII. 

On  Exercise,  Swedish  Gymnastics — Massage — Sport,  and 
Walking  and  Running  Exercise. 

All  kinds  of  exercise  have  one  essential  point  to  them — 
they  produce  a  contraction  of  the  muscles.  As  Ludwig  and  his 
disciples  have  shown,  contraction  of  the  muscles  produces  an 
increased  supply  of  blood  in  them ;  more  arterial  blood  being 
brought  to  the  muscles,  more  oxygen  and  heat  is  generated 
through  them,  which  results  in  a  general  increase  of  the  process 
of  oxidation. 

When  muscles  are  undergoing  contraction  impulses  are  con- 
veyed to  the  splanchnic  nerves,  which  are  the  regulators  of  the 
vasomotor  system.  Through  the  irritation  of  these  nerves,  the 
blood-vessels  of  the  internal  organs  supplied  by  the  splanchnics 
contract,  and  more  blood  is  despatched  to  the  periphery  of  the 
body.  The  capillaries  of  the  skin  will  be  dilated,  and  more 
blood  will  also  be  brought  to  the  sudorific  glands ;  these  also  ex- 
crete more  water,  which  takes  the  form  of  sweat.  Thus,  by  exer- 
cise that  causes  some  exertion,  abundant  perspiration  follows,  by 
which  means  we  can  obtain  the  advantages  we  have  mentioned 
in  the  chapter  on  the  hygiene  of  the  skin  and  kidneys;  and  it 
is  for  this  reason  also  that  we  place  this  chapter  on  exercise  im- 
mediately after  the  above-named  one. 

The  essential  point  in  these  exercises  is  that  a  great  part 
of  the  circulating  blood  will  be  brought  to  the  periphery  of  the 
body,  and  thus  the  congestion  of  the  internal  organs  will  be 
prevented  or  relieved.  Among  these  organs  the  kidneys  will 
be  benefited,  but  only  in  a  preventive  sense,  for  in  inflamma- 
tory conditions  of  the  kidneys,  especially  in  the  parenchymatous 
forms,  all  kinds  of  exercise  should  be  avoided.  Besides  the  kid- 
(244) 


Exercise,  Swedish  Gymnastics.  245 

neys  and  other  organs,  the  heart  also  may  benefit  by  exercise  if 
such  be  taken  in  moderation.  The  greatest  benefit,  especially 
for  those  with  a  diseased  heart,  will  follow  exercises  carried  out  in 
the  form  of  Swedish  gymnastics. 

The  originator  of  the  Swedish  gymnastic  movements  was 
Peter  Ling,  who  gained  great  credit  for  himself  and  his  country 
by  the  invention  of  this  system,  which  has  prolonged  the  life 
of  many  persons  suffering  from  chronic  ailments.  In  the 
Royal  Central  Institute  for  Gymnastics  in  Stockholm,  and 
also  in  private  schools  in  that  city,  many  experts  have  been 
trained  in  these  methods,  and  from  thence  they  have  spread  all 
over  the  world,  many  coming  to  the  United  States,  where  Dr. 
S.  Weir  Mitchell  introduced  these  salutary  systems,  and  also 
massage. 

Massage  was  known  thousands  of  years  before  Ling's 
time,  notably  in  India,  Java,  and  other  countries  of  the  Malayan 
race.  Even  the  great  Harvey  knew  the  effects  of  massage,  for 
he  quotes  the  case  of  a  man  who,  in  consequence  of  an  insult 
which  he  could  not  avenge,  became  so  overcome  with  passion 
and  rage  that  he  fell  into'  a  strange  disorder — suffering  from 
extreme  compression  and  pain  in  the  heart  and  chest,  from  which 
he  only  eventually  received  some  relief  when  his  chest  was  pum- 
meled  by  a  powerful  man — just  as  a  baker  kneads  dough.1 

The  essential  thing  in  massage  is  the  kneading  of  the  mus- 
cles. We  thus  artificially  increase  the  flow  of  the  blood  in  them 
through  the  local  irritation  of  the  skin  and  the  mechanical 
diffusion  of  the  blood  in  the  direction  of  the  muscle.  We  thus 
produce  artificial  hyperemia,  not  unlike  the  effects  of  a  mus- 
tard plaster,  and,  in  the  same  way  as  the  plaster,  we  are  also 
drawing  blood  from  the  congested  organs,  and  especially  from 
the  engorged  heart;  thus  we  obtain  a  better  distribution  of  the 
blood  throughout  the  body  and  facilitate  the  action  of  the  heart. 

It  has  been  shown  by  the  experiments  of  Sir  Lauder  Brun- 
ton  and  Tunnicliffe  that  kneading  the  muscles  increases  circu- 
1  Quoted  after  Sir  Lauder  Brunton,  Harveyan  Oration. 


246  Old  Age  Deferred. 


lation  through  them  in  the  same  manner  as  massage.  They 
found  that  during  such  kneading  the  amount  of  venous  blood 
which  issued  from  them  was  sometimes  diminished  and  sometimes 
increased ;  that  just  after  the  kneading  was  over  the  flow  dimin- 
ished (apparently  from  the  blood  accumulating  in  the  muscles), 
and  this  diminution  was  again  succeeded  by  a  greatly  increased 
flow.  The  clinical  results  are  precisely  what  one  would  expect 
from  increased  circulation  in  the  muscles,  and  cases  apparently 
hopeless  sometimes  recover  most  wonderfully  under  this  treat- 
ment. 

By  means  of  massage  the  functions  of  the  heart  can  thus 
be  facilitated,  for  massage  mechanically  diminishes  the  resistance 
of  small  capillaries  to  the  oncoming  blood-waves  sent  from  the 
heart.  It  mechanically  quickens  the  circulation  of  the  blood 
through  the  capillaries  by  dilating  them  in  a  way  similar  to  exer- 
cise (see,  also,  Chapter  XVIII). 

By  certain  massage  movements  applied  to  the  exterior 
region  of  the  heart — such  as  vibratory  massage — this  organ  can 
also  be  favorably  influenced ;  and  by  kneading,  friction,  and  mas- 
sage together  applied  to  the  periphery  of  the  body,  and  by  passive 
movements  of  the  extremities,  many  cases  of  heart  disease  have 
been  treated  with  good  results,  and  premature  death  prevented. 
Still  more  thorough  is  the  effect  of  such  treatment  if  carbonic 
acid  baths  are  used  in  connection  with  the  above,  as  at  Nau- 
heim,  for  such  baths  stimulate  the  skin,  which  becomes  better 
provided  with  blood.  We  have  referred  to  the  effect  of  such 
baths  in  a  previous  chapter  on  the  hygiene  of  the  skin  and  kidneys 
by  means  of  bathing. 

The  Nauheim  treatment  affords  good  results  in  mild  cases 
of  arteriosclerosis,  dilatation  of  the  heart,  and  various  other 
forms  of  heart  disease. 

Massage  is  also  an  excellent  thing  in  chronic  diseases  of 
metabolism,  as  it  helps  the  resorption  of  waste  products  and 
augments  the  processes  of  oxidation ;  in  cases  of  gout,  obesity, 
and  also  diabetes,  it  can  therefore  give  very  good  results. 


Exercise,  Swedish  Gymnastics.  247 


In  the  case  also  of  healthy  people  who  can  afford  to  be 
massaged  daily,  vital  functions  can  be  rendered  more  active  and 
youthfulness  prolonged ;  and  for  those  who  do  not  possess  facili- 
ties for  being  massaged  by  others,  they  can  perform  it  themselves 
by  friction,  rubbing  the  body  at  rising  and  just  before  going  to 
bed. 

The  Swedish  movements  can  also  be  performed  not  only  by 
free  gymnastics,  but  also  by  the  use  of  mechanical  apparatus,  such 
as  that  invented  by  Dr.  Zander  of  Stockholm.  These  movements, 
combined  with  massage,  also  give  good  results  in  many  of  the 
above-mentioned  ailments,  but  it  would  lead  us  too  far  to  enlarge 
upon  them  here. 

Much  more  strenuous  for  the  body  than  Swedish  move- 
ments and  massage  are  the  exercises  of  sports,  a  complete  de- 
scription of  which  would  exceed  the  limits  of  the  present  work; 
but  whether  it  be  football,  tennis,  golf,  athletics,  or  cycling,  the 
great  object  in  all  is  to  easily  create  perspiration,  by  which  the 
benefits  described  in  the  chapter  on  hygiene  of  the  skin  and 
kidneys  are  obtained.  It  goes  without  saying,  that  a  dis- 
eased state  of  the  kidneys  excludes  all  kinds  of  violent  exer- 
cise which  require  a  severe  bodily  movement.  By  means  of 
sport  the  processes  of  oxidation  are  also  rendered  more  active, 
and  thus  obesity  can  be  prevented  and  cured,  and  at  the  same 
time  the  waste  products  are  more  thoroughly  consumed.  Neu- 
rasthenic conditions,  insomnia,  etc.,  may  be  improved  if  the 
sport  adopted  does  not  lead  to  too  great  fatigue;  otherwise  they 
may  be  made  worse.  Taking  into  consideration,  however,  the 
conditions  of  the  circulatory  mechanism,  sport  is  a  two-edged 
sword.  If  undertaken  in  moderation  all  sport  can  improve  our 
physical  condition ;  but  it  may  prove  disastrous  if  reason  be  not 
exercised  and  it  is  indulged  in  to  excess.  By  the  strong  muscular 
exertions  referred  to  an  irritation  of  the  splanchnic  nerves  takes 
place,  resulting  in  a  high  blood-pressure;  more  blood  will  pass 
with  greater  vigor  through  the  arteries  and  capillaries,  which, 
consequently,  become  dilated.     If  this  occurs  too  frequently  they 


248  Old  Age  Deferred. 


will,  as  is  only  natural,  lose  their  elasticity,  in  which  case  degen- 
eration of  the  arteries  and  development  of  arteriosclerosis  may 
follow. 

When  a  succession  of  severe  muscular  exertions  takes  place 
an  accumulation  of  blood  occurs  in  the  right  side  of  the  heart, 
and,  as  the  right  ventricle  cannot  empty  itself,  shortness  of 
breath,  and  even  death,  may  result.  The  left  ventricle  then  be- 
comes dilated,  and  such  dilatation  of  the  heart  not  infrequently 
persists  for  a  long  time,  even  in  persons  who  have  been  in  good 
health  before  undertaking  severe  exercises.  If,  therefore,  the 
normally  healthy  may  suffer  from  an  irrational  indulgence  in 
sport,  how  much  more  fatal  must  be  the  results  to  those  with 
heart  or  kidney  complaints,  and  with  degenerative  conditions  of 
the  blood-vessels  ? 

To  persons  of  advanced  age  sport  may  be  very  pernicious, 
for  here  the  elasticity  of  the  arteries  is  wanting;  they  are  more 
rigid,  and  consequently  cannot  so  readily  dilate.  Overexertion 
in  such  cases  may  lead  to  the  gravest  results. 

As  those  engaged  in  sport  lose  a  large  quantity  of  fluid, 
they  soon  feel  thirsty,  and  so  may  be  inclined  to  make  up  the 
deficiency  of  water  in  the  blood  by  partaking  of  alcoholic  bever- 
ages, such  as  beer,  whisky,  or  wine;  and  if  such  are  taken  in 
large  quantities,  necessarily  further  dilatation  of  the  heart  and 
blood-vessels  will  result,  as  is  usual  from  the  frequent  use  of 
large  quantities  of  liquids,  not  taking  into  account  the  mischief 
caused  to  the  various  organs  by  the  alcohol.  As  a  general  form 
of  exercise  sport  in  moderation  can  be  beneficial  to  the  heart. 
Naunyn  has  shown  that  blood-pressure  falls  from  continuous 
exercise,  and  Masey  has  also  demonstrated  this  on  galloping 
horses.  The  best  form  of  exercise  is  walking  or  moderate 
climbing.  Moritz  has  shown  that  after  exercise  the  volume  of 
the  heart  is  diminished,  and  the  rate  of  the  pulse  increased. 

There  are  certain  sports  which  do  not  require  great 
bodily  exertion,  and  these  are,  in  consequence,  less  harmful  to 
the  heart.     Take,  for  example,  horseback  riding,  which  produces  a 


Exercise,  Swedish  Gymnastics.  249 

more  or  less  accentuated  rhythmic  shaking  movement  of  the  body. 
In  a  particular  style  of  riding  called  "the  English  trot,"  the  body 
rises  and  falls  at  regular  intervals,  which  causes — as  we  noted 
in  our  own  person — free  perspiration ;  the  circulation,  especially 
in  the  abdominal  organs  and  lower  extremities,  is  also  pro- 
moted. We  consider  riding  to  be  one  of  the  most  beneficial 
kinds  of  exercise.  We  frequently  note  the  healthy  appearance 
of  horseback  riders  (except  jockeys,  who  are  underfed  in  their 
training).  A  well-known  member  of  the  medical  faculty  in  Ber- 
lin, a  world-renowned  specialist,  was  a  great  horseman.  He  took 
part  in  the  last  Medical  Congress  in  Dresden,  coming  on  horse- 
back through  the  pouring  rain  from  Berlin.  Possibly  his  good 
health  was  due  to  the  vigorous  exercise  of  which  he  was  so  fond. 
By  a  strange  irony  of  fate,  this  enthusiastic  admirer  of  riding 
died  in  consequence  of  an  accident  caused  by  his  automobile  a 
short  time  ago. 

In  certain  kinds  of  sport,  such  as  riding  and  cycling,  the 
greater  possibility  of  accidents  is  a  drawback,  and  in  nervous 
individuals  serious  traumatic  neurosis,  and  often  diabetes,  may 
sometimes  develop,  particularly  in  those  cases  where  such  people 
are  descended  from  diabetic  parents.  We  published  a  case  of  this 
kind  some  years  ago.  For  such  people  this  kind  of  exercise 
should  be  prohibited,  especially  in  those  descended  from  diabetic 
parents.  Cycling  has  the  additional  drawback,  according  to 
Zunz,  that  from  it  fatigue  is  not  so  soon  felt,  and  thus  overin- 
dulgence may  more  easily  occur. 

Less  injurious  than  sport,  and  much  easier  to  be  performed, 
is  walking  exercise.  As  walking  on  the  level  does  not  necessitate 
great  exertion,  unless  performed  rapidly,  it  can  give  good  results 
if  continued  for  a  considerable  distance.  It  is  desirable  to  walk 
as  much  as  possible,  and  never  to  use  a  street  car  or  a  carriage 
unless  pressed  for  time;  by  this  means  health  may  be  greatly 
improved.  In  walking  especially  the  muscles  of  the  lower  ex- 
tremities are  contracted,  and  at  the  same  time  the  circulation  is 
improved,  the  more  so,  of  course,  in  the  lower  extremities,  but 


250  Old  Age  Deferred. 


also  in  other  parts  of  the  body;  and  this  is  still  more  the  case 
when  we  walk  briskly.  For  those  possessing  a  good  circulatory 
mechanism,  it  is  always  advisable  to  walk  briskly,  thus  indulging 
in  a  healthy  and  practical  and  muscular  exercise ;  and  for  such,  also, 
running  for  a  few  minutes  several  times  daily  is  excellent,  as 
perspiration  can  thus  be  created,  whereby  harmful  products  are 
eliminated  from  the  body.  This  latter  exercise  is  more  suited  to 
those  living  in  the  country,  or  if  in  cities,  to  those  who  have  a 
garden  or  large  yard. 

It  is  advisable  not  to  run  too  fast,  as  such  would  cause  severe 
exertion  with  bad  effects  upon  the  heart ;  but  if  undertaken  at  all 
it  should  only  be  for  a  minute  or  so.  Running  at  a  moderate 
speed,  breathing  deeply  and  rhythmically  at  the  same  time,  and 
with  rhythmical,  rather  short  steps,  can  be  kept  up  even  for 
eight  to  ten  minutes  without  any  particular  harm  to  the  circu- 
latory system.  Personally  we  used  to  do  this,  and  often,  when 
the  thermometer  stood  below  zero,  without  hat  or  overcoat, 
finishing  thoroughly  warm  and  comfortable.  Standing  still  after 
running,  when  so  attired,  might  lead  to  catching  cold,  but  run- 
ning out  of  the  house  and  back  again  without  stopping  causes  no 
such  risk,  even  in  a  strong  wind,  as  we  have  personally  proven. 
Such  running  may  best  be  done  three  times  a  day,  before  break- 
fast, dinner,  and  supper,  as  this  running  in  and  out  of  the  garden 
is  the  best  of  appetizers,  and  is  far  more  beneficial  than  drugs  for 
those  men  and  women  who  sit  about  all  day  and  complain  of 
want  of  appetite.  Such  running  practice  is  only  good  for  those 
who  have  sound  blood-vessels,  heart  and  kidneys.  Deep  regular 
breathing  while  exercising  is  also  indispensable. 

Walking  up  a  hill  will  naturally  require  greater  exertion 
than  walking  on  the  level,  and  may  be  more  beneficial  to  the 
health  than  sports  conducted  to  a  similar  degree.  At  first  the 
blood-pressure  will  increase,  but  it  will  afterward  decrease. 
Deeper  respirations  will  have  to  be  taken,  so  that  a  larger  supply 
of  oxygen  will  be  brought  to  the  lungs  and  tissues. 

Climbing  high  mountains  should  be  strictly  forbidden  per- 


Exercise,  Szvedish  Gymnastics.  251 

sons  suffering  from  disease  of  the  heart  and  arteriosclerosis, 
for  the  greater  exertion  then  required  has  often  caused  death 
in  persons  so  afflicted.  To  prevent  the  bad  circulatory  effects 
of  climbing  it  is  necessary  to  breathe  deeply  and  regularly,  and 
this,  indeed,  should  not  be  overlooked  in  all  forms  of  exercises; 
even  masseurs  are  unable  to  work  properly  unless  they  take  deep 
regular  breathing. 

In  mild  cases  of  heart  trouble,  and  even  in  more  serious 
cases  if  applied  judiciously,  Oertel's  treatment  of  each  day  slowly 
walking  up  a  steeper  and  steeper  hill  will  give  good  results,  giving 
good  training  for  the  heart  muscle.  But  this  treatment  should 
only  be  carried  out  under  the  direction  of  a  competent  specialist. 

The  great  advantage  of  the  various  kinds  of  sport  and  of 
walking,  climbing,  and  running  exercise  is  that  several  other 
agencies  can  be  combined  with  them  that  are  very  important  in 
the  treatment  and  prevention  of  the  effects  of  old  age.  These 
are  fresh  air  and  sunshine.  We  think  that  the  combination  of 
the  three  agencies — exercise,  fresh  air,  and  sunshine — is  the  best 
and  most  necessary  means  for  the  preservation  of  youthfulness 
and  for  the  prolongation  of  life. 


CHAPTER  XXIX. 

A  Few  Remarks  on  Cold  Feet — Their  Cause  and 
Treatment. 

It  is  intentional  that  we  present  this  chapter  immediately 
after  those  on  the  improvement  of  the  functions  of  the  skin  and 
on  exercise,  as  these  are  the  principal  means  by  which,  as  a 
general  rule,  we  are  able  to  prevent  cold  feet. 

These  are,  for  the  most  part,  occasioned  by  an  insufficient 
supply  of  arterial  blood  to  the  extremities.  This  can  be  caused 
either  by  a  hindrance  to  the  circulation — as  for  example  in  the 
case  of  irrational  use  of  articles  of  clothing — or  through  the 
want  of  muscular  contraction  by  exercise.  In  old  people, 
especially,  cold  feet  can  be  occasioned  by  the  degenerative  altera- 
tions of  the  blood-vessels,  in  consequence  of  which  less  arterial 
blood  reaches  the  feet.  If  to  this  anatomical  cause  there  are 
other  factors  added,  then  naturally  the  sensation  of  cold  feet  will 
much  more  easily  result.  We  must  bear  in  mind  that  the  feet, 
like  the  nose  also,  are  the  most  distant  parts  of  the  body  from  the 
center  of  the  circulatory  system — the  heart,  so  that  naturally  in 
these  parts,  through  the  less  effective  warmth  of  the  arterial 
blood  in  old  people,  and  even  in  younger  anaemic  women,  the 
sensation  of  cold  will  easily  arise. 

Cold  feet  through  irrational  clothing  can  be  caused  by  using 
garters  or  thick  footwear  with  tight  shoes,  owing  to  the  circu- 
lation of  the  blood  being  thus  impeded  in  the  lower  extremities. 
It  is  of  no  use  to  wear  the  thickest  woolen  socks  or  stockings  as  a 
protection  against  cold  feet,  which  should  serve  to  retain  the 
natural  warmth  of  the  feet,  and  then  to  prevent  this  warmth  be- 
ing given  off,  this  latter  resulting  in  the  sensation  of  cold  feet. 
But  how  can  this  thick  footwear  retain  the  heat,  the  generation 
of  which  it  prevents  by  mechanically  compressing  the  blood- 
vessels and  thus  rendering  the  influx  of  warm  blood  impossible? 
(252) 


Cold  Feet.  253 

It  is  also  useless  to  wear  thick  socks  if  there  be  no  layer 
of  air  between  them  and  the  skin,  which  layer  is  the  best  means 
of  retaining  warmth,  as  mentioned  in  the  chapter  on  the  hygiene 
of  the  skin  in  connection  with  rational  clothing.  Neither 
the  footwear  nor  the  shoes  must,  therefore,  be  close  fitting. 
Many  people  wear  such  tight-fitting  socks  or  stockings,  and  boots 
or  shoes,  that  the  pattern  of  the  socks  is  impressed  on  the  feet, 
in  which  case  of  course  it  need  cause  no  surprise  if  they  complain 
of  cold  feet  in  spite  of  the  thickness  of  their  socks  or  stockings. 

As  already  mentioned  in  the  chapter  on  hygienic  clothing, 
it  would  be  preferable  to  wear  thin  wool  of  the  best  quality  and 
low  half-shoes;  when  so  clad  we  will  not  suffer  from  cold  feet 
if  we  take  exercise.  The  writer  of  this  book  wears  such  even 
in  winter,  in  which  season  he  puts  on  gaiters  only  when  the  tem- 
perature is  below  20°  F.  On  some  very  cold  days  he  might 
feel  cold  in  them,  but  then  only  in  the  morning,  for  after  a 
brisk  walk,  or  better,  after  a  smart  run  (see  previous  chap- 
ter) the  cold  sensation  disappears  for  the  rest  of  the  day. 

Exercise  is,  as  a  rule,  the  best  preventative  against,  and  the 
best  method  of  treatment  for,  cold  feet,  as  it  is  through  the 
muscular  contraction  produced  by  walking  or  running  that  heat 
is  generated,  as  explained  in  the  previous  chapter  on  exercise. 

Rubbing  and  massage  of  the  feet  will  produce  results 
similar  to  those  obtained  by  exercise,  and  are  still  more  effective 
if  supplemented  by  walking. 

When  we  sit  still  our  body  will  naturally  cool  off.  It  is 
therefore  a  good  plan  to  make  circular  or  other  movements  with 
the  feet  and  not  allow  them  to  remain  still  if  we  feel  cold  in 
them. 

While  residing  as  a  guest  with  an  elderly  lady,  the  head 
of  an  aristocratic  Dutch  family,  I  observed  her  putting  her  feet 
on  a  silver  warming  utensil,  in  which  her  footman  constantly 
burnt  a  little  oil  lamp,  in  order  to  keep  her  feet  warm.  I  told 
her  she  could  easily  dispense  with  this  if  she  would  make  up  her 
mind  to  take  exercise  on  foot  instead  of  driving  in  her  luxurious 


254  Old  Age  Deferred. 


carriage,  and  not  confine  herself  to  merely  walking  from  one 
room  to  another. 

Defective  circulation  of  the  blood  to  the  feet  can  not  only- 
result  in  cold  feet,  but  also  in  very  serious  ailments, 'and  even  in  a 
shortening  of  the  ordinary  span  of  life.  Thus,  in  consequence  of 
a  deficient  influx  of  arterial  blood  and  the  stagnation  of  the 
venous  circulation,  especially  in  old  people  with  sclerotic  changes 
of  the  blood-vessels,  a  very  trying  and  long-continued  ulceration 
of  the  feet  may  result.  By  bringing  more  arterial  blood  to  the 
feet  and  causing  hyperemia,  according  to  Bier,  we  can  cure  this 
condition. 

Still  more  serious  consequences  may  be  brought  about  by 
defective  circulation  in  the  feet,  and  especially  in  the  toes,  in 
the  form  of  senile  gangrene,  which  is  far  more  frequently  found 
in  diabetic  persons,  and  sometimes  even  before  the  com- 
mencement of  old  age.  In  cases  of  arteriosclerosis,  where  cold 
feet  are  the  consequence  of  defective  blood-supply  owing  to  arte- 
rial degeneration,  iodides  together  with  thyroid  extracts  will  be 
found  successful.  They  produce  a  dilation  of  the  blood-vessels, 
diminish  the  viscosity  of  the  blood,  and  thus  produce  the  sen- 
sation of  heat.  The  method  of  application  will  be  found  in  the 
chapter  on  the  treatment  of  old  age  by  organic  extracts. 

As  the  promotion  of  a  hygienic  condition  is  an  excellent 
preventative  against  cold  feet  and  also  excellent  for  their  treat- 
ment we  repeat  again  that  a  foot-bath  should  be  used  daily  in 
such  cases,  and  not  only  warm,  but  also  cold  water  should  be  used 
therein.  Cold  water  acts  as  already  mentioned  as  a  stimulant 
when  applied  as  a  foot-bath ;  but  it  should  only  be  used  for  a  very 
short  time,  after  which  energetic  rubbing  of  the  feet  will  produce 
active  circulation  and  the  feeling  of  warmth  in  them.  We  recom- 
mend for  cold  feet  to  rub  them  with  a  cold  wet  towel,  then  to 
pour  over  them  a  little  eau  de  cologne  or  alcohol,  and  again  rub 
them  till  they  begin  to  become  red ;  'we  must  next  move  the  toes 
forward  and  backward  twenty  or  thirty  times  with  our  hand. 
We  will  then  feel  in  the  feet  a  sensation  of  agreeable  warmth. 


CHAPTER   XXX. 
On  the  Benefits  of  Sunlight. 

It  is  a  matter  of  everyday  observation  that  when  we  leave 
plants  in  a  room,  where  no  sunshine  can  penetrate,  they  lose 
their  color  and  soon  show  quantities  of  parasites.  Similar  changes 
occur  in  persons  who  live  in  dark  rooms  and  seldom  come  into  the 
sunlight.  They  become  pale,  and  are  liable  to  all  kinds  of  bacil- 
lary  infections,  especially  tuberculosis.  An  Italian  proverb  says, 
very  justly,  "Dove  no  viene  il  sole  viene  il  medico" — "Where 
comes  no  sun,  the  physician  is  coming,"  and  a  German  proverb 
again  says,  "Auf  die  schattige  seiteder  strasse  kommf  der 
Leichenwagen  doppelt  so  oft,  als  auf  die  sonnige,"  which  means 
in  English,  "The  funeral  coach  turns  twice  as  often  on  the 
shady  side  of  the  street  as  on  the  sunny  side,"  which  saying, 
like  most  proverbs,  contains  much  truth. 

We  often  notice  that  on  days  when  there  is  no  sunshine  espe- 
cially when  at  the  same  time  it  is  cold  and  damp,  we  feel  de- 
pressed in  mind.  In  such  an  atmosphere  there  is  a  diminution 
of  the  respiratory  and  transpiratory  functions  of  the  skin,  and, 
in  consequence,,  a  retention  of  toxic  products.  On  the  other 
hand,  on  sunny  and  dry  days  these  functions  are  facilitated,  and 
there  is  less  work  to  be  thrown  upon  the  kidneys.  Such  a  rest 
does  good  to  an  organ  that  is  almost  constantly  at  work,  and 
is  a  wise  economy  for  the  days  of  old  age.  It  is  astonishing  how 
sunshine  can  influence  our  mental  condition.  We  feel  better 
able  to  work,  and  also  to  take  out-door  exercise,  on  sunny  days. 
Particularly  in  old  age  is  sunshine  precious,  and  we  see  our  old 
house  dog  and  our  cat  lying  in  the  sunshine  and  taking  a  sun 
bath.  In  the  same  way,  instinct  tells  old  people  that  the  sun  is 
good  for  them,  and  thus  they  eagerly  watch  for  it  to  shine,  and 
like  to  sit  in  it,  especially  on  cold  days. 

(255) 


256  Old  Age  Deferred. 


It  has  been  shown  by  exact  researches  that  the  sun's  rays 
can  kill  bacteria,  and  statistics  have  shown  that  in  sunny  weather 
there  are  fewer  infectious  diseases,  like  influenza,  than  in  dull 
weather.  In  sunshine  there  are  two  elements  which  possess  anti- 
toxic and  healing  properties :  light  and  warmth.  Its  light  is 
made  use  of  in  the  treatment  of  certain  infectious  diseases,  like 
lupus  (Finsen  treatment).  Both  these  properties  can  be  used 
to  great  advantage  in  the  sun-bath  treatment.  Lying  in  the  sun 
for  a  certain  length  of  time  causes  a  dilatation  of  the  blood-vessels 
and,  later  on,  abundant  perspiration. 

The  ancient  Romans  made  use  of  the  therapeutic  action 
of  sunshine,  and  many  of  them  took  sun-baths  on  the  roofs  of 
their  houses.  There  were  also  public  sun-baths,  much  visited 
by  the  population.  The  ancient  physicians  recognized  the  value 
of  sunshine  in  the  treatment  of  various  ailments.  According  to 
Hippocrates,  the  sun-bath  augments  transpiration  and  makes 
us  more  resistant  against  disease,  giving  us  more  strength. 
Celsus  also  advised  its  use  in  nervous  diseases. 

Certain  people  have  undertaken  scientific  experiments  on 
animals  to  prove  the  great  effects  of  light.  Moleschott,  the 
great  physiologist,  found  that  the  embryos  of  frogs  gave  off 
far  more  carbonic  acid  under  the  influence  of  light  than  when 
they  were  in  the  dark.  The  stronger  the  light  the  more  carbonic 
acid  was  given  off.  Edwards  found  that  such  ernbryos  could  not 
develop  at  all  in  the  dark. 

Very  important  was  the  discovery  of  Arloing,1  and  also  of 
Duclaux,2  that  the  growth  of  bacteria  when  exposed  to  the  sun 
is  checked,  and  that  later  on  they  will  even  be  killed.  This  is 
mainly  due  to  the  action  of  blue  and  ultra-violet  rays. 

The  chemical  action  of  sunlight  is  exercised  by  the  blue 
and  ultra-violet  rays  (Finsen),  and  the  heat  comes  mainly  from 
the  red  rays.  From  our  point  of  view,  however,  the  chemical 
rays  play  the  more  important  part. 

1  Arloing:     C.  R.  de  l'Academie  des  Sciences,  p.  37S  et  511,  Paris,  1885. 

2  Duclaux:     Revue  Scient.,  1887. 


Benefits  of  Sunlight.  257 


When  we  sit  in  the  sun  for  a  long  time  and  get  an  inflamed 
skin,  this  is  due  mainly  to  the  chemical  rays.  This  fact  was 
established  by  Charcot  on  the  basis  of  clinical  observations. 
Charcot's  work  has  been  confirmed  by  the  researches  of  Wid- 
mark,  and  especially  by  the  exact  experiments  of  the  famous 
Danish  physician,  Niels  Finsen,3  in  1906.  The  latter  showed 
that  when  strong  light  killed  bacteria,  this  was  due  to  the 
action  of  the  chemical  rays  alone,  and,  specifically,  to  the  ultra- 
violet rays.  He  also  showed  that  these  are  the  rays  which  pro- 
duce dilatation  of  the  blood-vessels  and  an  inflammatory  condi- 
tion of  the  skin. 

To  the  red  cheeks  of  those  people  who  pass  much  time  in 
the  open  air  and  sun,  we  can  compare,  as  a  contrast,  the  pale 
faces  with  a  greenish  hue  of  those  who  live  in  the  dark,  like  polar 
explorers.  If  strong  light  dilates  the  blood-vessels,  and  sends 
much  blood  to  the  periphery  of  the  body,  thus  promoting  the 
insensible  perspiration  and  metabolism,  on  the  other  hand,  in 
the  long  night  of  the  arctic  regions  there  is  contraction  of  the 
blood-vessels,  and  the  blood  is  kept  back  in  the  interior  of  the 
body,  with  the  retention  of  excretory  products.  It  has  been 
shown  by  Oerum,4  through  experiments  on  animals,  that  the 
quantity  of  their  blood  and  its  percentage  of  haemoglobin  is 
dependent  upon  the  light.  They  are  reduced  in  the  darkness 
and  increased  in  the  light  Through  a  light  bath  the  quantity 
of  blood  was  increased  25  per  cent,  within  four  hours. 
Finsen5  has  also  found,  through  examination  of  twenty-nine 
persons,  that  there  is  less  haemoglobin  in  the  blood  in  winter 
than  in  summer,  due  to  the  lack  of  sunlight  in  winter.  Grawitz 
and  GrafTenberger  have  seen  a  diminution  of  the  haemoglobin, 
as  also  of  the  quantity  of  the  whole  blood,  in  animals  which  were 
kept  in  the  dark.     Marti  found  that  the  red  blood  corpuscles  are 


3  Finsen :       "Om    anvendelsen    af    concentrerede    chemiske    Lysstraaler,' 
Kjobenhavn,  1896. 

4  Oerum :     Pfliiger's  Archiv.  f .  d.  g.  Physiologie,  vol.  exiv. 

5  Hospitalstidende,  p.  1209  and  1239,  1894. 

17 


258  Old  Age  Deferred. 


diminished  in  such  animals,  but  become  augmented  when  they 
are  again  exposed  for  a  time  to  the  sunshine. 

We  should  aim  to  get  our  share  of  direct  sunlight  in  the 
open  air,  for,  as  Finsen  has  shown,  the  valuable  chemical  rays  of 
the  sun  are  excluded  by  glass;  and,  after  all,  it  is  not  warmth 
alone  we  seek,  but  also  the  chemical  and  anti-bacterial  action  of 
the  sunlight,  together  with  its  effects  upon  the  blood-vessels  and 
nervous  system. 

To  absorb  as  much  of  the  active  rays  as  possible,  it  is  best 
to  wear  light  or  light  blue  or  light  gray  clothing,  which  allows 
the  sun's  rays  to  pass,  whereas  dark  cloth  does  not,  as  found  by 
Boubnoff  and  Lenkey.  The  rays  of  the  sun  are  always  valuable, 
but  their  action  varies  with  the  altitude.  Thus,  the  higher  the 
altitude  and  the  rarer  the  atmosphere,  the  more  efficacious  will 
be  the  action  of  the  sun's  rays.  In  lower  altitudes  the  rays  have 
to  pass  through  dense  strata  of  air  filled  with  vapors  of  carbonic 
acid  and  dust,  and  thus  much  of  their  strength  is  lost.  As 
Prof.  Mohn6  says  in  his  book  on  "Meteorology" :  "The  rays 
of  the  sun  in  transit  meet  always  denser  and  denser  air,  which 
contains  large  quantities  of  vapor,  carbonic  acid,  and  dust.  A 
part  of  their  strength  is  absorbed  by  the  substances  contained 
in  the  air,  and  these,  as  well  as  the  air,  are  heated.  Hereby  some 
of  the  power  of  the  sunshine  gets  lost,  as  the  rays  of  the  sun 
are  reflected  off  these  substances.  Furthermore,  they  pass 
through  clouds.  Hence  the  rays  of  the  sun  lose  more  and  more 
of  their  strength  before  they  reach  the  earth." 

It  is  also  an  important  fact  that  the  higher  the  altitude,  the 
more  numerous  are  the  chemical  rays  of  the  sun  which  have 
the  greatest  heating  properties.  In  high  localities  sunshine  con- 
tains much  more  of  the  blue  and  ultra-violet  rays,  whose  won- 
derful action  upon  the  red  blood-corpuscles  has  been  shown  by 
the  experiments  of  Niels  Finsen.7  Not  only  on  the  blood,  but 
also  on  the  nerves,  they  exercise  a  tonic  action.    As  Niels  Finsen 


6  Mohn:     Quoted,  after  Holm,  Norsh  Magazin.  Laege,  W.  6,  1906. 

7  Meddelelsei*  fra  Finsen's  "Chemiske  Lysinstitut,"  Kjobenhavn,  1899. 


Benefits  of  Sunlight.  259 


has  shown,  it  is  due  to  these  blue  and  violet  rays  that  insects 
regain  their  vitality  as  soon  as  the  sun  shines.  As  Dr.  Holm 
says,  it  is  probably  due  to  these  rays  that  the  quantity  of  red 
blood-corpuscles  and  of  haemoglobin  is  increased  at  altitudes 
of  500  or  600  meters  above  the  sea  level,  as  found  by  Viault8  and 
Mintz.9 

As  a  logical  consequence  of  the  above,  we  must  try  to  enjoy 
sunshine  on  mountains,  or  on  the  terraces  of  high  buildings,  as 
there  can  be  no  doubt  but  that  sunshine  is  more  beneficial  in  such 
places.  In  high  altitudes  sunshine  is  far  more  warming  than 
lower  down,  probably  due  to  the  fact  that  the  sun's  rays  pass 
fewer  strata  with  vapor  and  foreign  substances,  and  thus  less 
of  their  warmth  is  absorbed.  Thus  we  can  explain  the  observa- 
tions that,  by  exposure  for  a  certain  time  to  the  rays  of  the  sun 
on  the  top  of  high  mountains  in  mid-winter,  erythematous  or 
eczematous  eruptions  were  produced.  At  such  great  heights  the 
air  is  usually  very  dry,  and  so  there  is  less  loss  of  heat  from 
the  body.  Therefore  we  can  sit  comfortably  in  the  sun  at  such 
heights  without  an  overcoat,  even  in  winter,  whereas  several 
hundred  meters  lower  down  we  should  feel  cold  even  with  an 
overcoat  on,  especially  in  a  coast  climate. 

Let  us  be  grateful  for  every  ray  of  sunshine  and  take  ad- 
vantage of  it.  Some  ladies  avoid  the  sun,  but  it  would  be  wiser 
to  seek  it  and,  if  possible,  to  expose  our  whole  bodies  to  its  rays. 
Let  us  remove  all  the  curtains  from  the  rooms  in  which  we  sleep 
or  sit,  especially  from  our  work  room.  In  the  train  let  us 
sit  on  the  sunny  side,  and  not  draw  the  curtain  unless  we  are 
reading;  in  short,  let  us  seek  the  sun  wherever  it  shines.  We 
shall  soon  observe  how  much  better  we  feel  after  a  long  sojourn 
in  the  sun.  We  have  often  been  surprised  at  the  appearance  of 
patients  whom  we  have  sent  for  a  holiday  to  the  Riviera  in  Egypt 
or  to  other  sunny  places.  Thus  we  have  often  seen  pale  patients 
come  back  rosy-cheeked  and  flourishing,  and  in  our  own  case  we 

8  Viault:     C.  R.  Acad.  Sciences,  p.  917,  1890  and  p.  295,  1891. 

9  Mintz:     C.  R.  Acad.  Sciences,  p.  298,  1891. 


260  Old  Age  Deferred. 


have  observed  the  same  thing  after  staying  in  California,  Arizona, 
Mexico,  and  Florida  for  several  weeks.  There  is  no  denying  that, 
as  a  rule,  those  who  spend  much  time  in  the  sun  look  better  and 
healthier  than  those  who  live  in  dark  rooms  or  offices.  It 
must  be  understood  that  we  are  talking  about  sunshine  at  a 
moderate  temperature.  But  even  a  somewhat  higher  tempera- 
ture, with  sunshine,  can  do  no  harm,  especially  to  persons  suf- 
fering from  chronic  kidney  trouble.  In  old  age,  as  in  other 
conditions  of  athyroidia,  we  often  find  chronic  interstitial  nephri- 
tis and  sluggish  kidney  functions.  Therefore  we  should  relieve 
the  kidneys  of  any  overwork  and  make  the  skin  do  more,  which 
can  be  accomplished  by  warm  sunshine.  Old  people,  if  their 
means  allow  it,  should  never  be  left  to  pass  a  winter  in  cold  cli- 
mates, but  should  be  sent  to  warm  sunny  climates  like  the  Riviera, 
Egypt,  or  California  or  Florida  in  America.  They  require  as 
much  sunshine  as  possible.  Americans  may  use  with  great  profit 
the  climatological  charts  of  Dr.  Charles  Denison,  of  Denver, 
Colo.,  which  show  with  great  exactness  those  parts  of  America 
where  the  greatest  number  of  sunny  days  occur. 

Against  old  age  sunlight  should  be  regarded  as  an  excel- 
lent protection.  It  safeguards  our  kidney  functions  by  promot- 
ing skin  activity,  and  it  aids  the  processes  of  metabolism.  It  is 
best  used  in  combination  with  exercise,  like  riding  or  some  form 
of  sport,  and  a  daily  sun  bath.  It  is  our  belief  that,  by  such 
means,  both  youth  and  life  may  be  prolonged. 

The  wonderful  effects  of  sunshine  are  illustrated  by  an 
interesting  experiment  of  Benjamin  Franklin.  According  to 
Hufeland10  this  savant  had  received  wine  from  Madeira  which  he 
was  putting  into  bottles  on  his  Virginia  estate.  In  this  wine  he 
found  a  few  flies,  which  were  apparently  dead.  The  sharp- 
minded  savant  put  these  flies  in  the  July  sun  of  the  hot  Virginian 
climate,  and  before  long  the  life  that  had  been  so  long  interrupted 
appeared  again.     The  flies  became  lively  and  soon  flew  away. 


10  Hufeland:     "Makrobiotik,"  p.  129. 


Benefits  of  Sunlight.  261 

They  thus  showed  the  same  reaction  to  the  beneficent  effects  of 
sunshine  as  the  insects  in  the  above-mentioned  experiment  of 
Niels  Finsen.  The  fly  is  a  most  objectionable  animal,  but  it 
possesses  one  good  trait  that  reconciles  me  to  its  existence ;  and 
that  is  that  it  is  so  fond  of  the  sunlight  that  it  may  thereby 
serve  as  an  example  to  those  foolish  people  who  do  their  best  to 
avoid  it. 


CHAPTER  XXXI. 

On  the  Advantages  of  an  Open  Air  Life  and  of  Breathing 

Exercises. 

When  we  note  the  faces  of  persons  who,  by  reason  of  their 
occupations,  pass  their  lives  in  the  open  air,  such  as  peasants, 
gardeners,  etc.,  we  usually  find  them  healthy  and  fresh-look- 
ing, and  looking  more  youthful  than  their  actual  age.  This 
is  especially  so  in  the  case  of  their  wives  and  daughters,  who  are 
more  exempt  from  certain  injurious  habits,  such  as  smoking, 
and  are  less  addicted  to  other  harmful  agencies,  like  alcohol. 
Their  fresh  rosy  faces  speak  in  eloquent  terms  of  the  benefits  of 
fresh  country  air. 

On  the  other  hand  we  see  that  others,  whose  daily  avoca- 
tions compel  them  to  stay  all  day  in  a  close  atmosphere,  very 
frequently  look  pale  and  sickly.  Among  such  persons,  as  ob- 
servation shows,  infectious  diseases  are  frequent,  and  especially 
tuberculosis.  This  disease  most  frequently  develops  in  persons 
who  pass  all  their  time  in  close  places,  especially  when  they  are 
poorly  fed  at  the  same  time.  We  can  trace  this  plainly  in  the 
working  classes  in  certain  European  countries  where,  in  Vienna, 
for  instance,  until  the  past  several  years,  about  70  per  cent,  of  the 
total  mortality  was  due  to  tuberculosis. 

If  we  now  take  such  tuberculous  persons  and  place  them  in 
a  hospital  or  sanatorium  and  subject  them  to  the  open  air  treat- 
ment, compelling  them  to  pass  all  their  time  exposed  to  the  fresh 
air,  both  day  and  night,  we  soon  witness  a  marvelous  change. 
Their  appearance  is  improved,  and  also  their  appetite ;  and  after 
a' time  in  most  of  the  cases  there  will  be  an  increase  in  bodily 
weight.  We  thus  see  that  the  open  air  produces  wonderful 
effects  in  such  persons,  who,  as  a  rule,  have  been  immured  in 
close  places,  they  shattering  their  health. 
(262) 


Open  Air  Life  and  Breathing  Exercises.  263 

We  have  thus  witnessed  the  clinical  demonstration  of  the 
fact  that  fresh  air  is  able  to  improve  our  health.  Fresh  air  con- 
tains much  oxygen,  and  this  is  a  most  indispensable  substance, 
for  without  it  we  cannot  live.  The  red  corpuscles  in  the  blood 
which,  loaded  with  carbonic  acid,  the  veins  convey  to  the  lungs, 
eagerly  absorb  the  oxygen  from  the  air  that  we  inhale  and  then 
convey  it  to  the  tissues  to  satisfy  their  requirements  for  this 
precious  substance. 

By  absorbing  oxygen  the  elimination  of  carbonic  acid  is 
at  the  same  time  facilitated.  The  greater  the  number  of  red 
blood  corpuscles  that  comes  to  the  surface  of  the  lungs  the  greater 
will  be  the  volume  of  oxygen  which  is  taken  into  the  system,  and 
afterwards  the  larger  will  be  the  volume  of  carbonic  acid  gas 
expelled.  Thus  in  the  lungs  there  takes  place  a  disintoxication 
of  the  organisms,  and,  according  to  certain  authorities,  the  cells 
of  the  lungs  are  co-operating  in  this  process  in  a  manner  analo- 
gous to  the  internal  secretion  by  the  cells  of  other  glandular 
structures. 

The  more  fresh  air,  i.e.,  the  more  oxygen  we  get  into  our 
lungs,  the  more  we  can  contribute  to  the  processes  of  oxidation 
in  the  tissues.  When  the  processes  of  circulation  and  of  breath- 
ing are  checked,  and  when  insufficient  oxygen  is  absorbed,  we 
soon  see  a  very  important  change  for  the  worse  in  the  condition 
of  such  persons,  as  exemplified  by  cases  of  heart  and  lung  trouble. 

Given  the  great  importance  of  oxygen,  we  must  try  by  every 
means  to  get  as  much  of  it  into  our  lungs  as  possible;  we  shall 
get  more  of  it  from  air  that  is  not  stagnating,  but  always  in  cir- 
culation. When  we  are  in  a  closed  room,  after  a  certain  time  we 
absorb  all  the  oxygen  in  it,  particularly  when  there  are  several 
persons  present  who  are  sharing  with  us  the  oxygen  in  the  air. 

Staying  for  a  long  time  in  air  so  vitiated  that  it  contains  but 
little  oxygen  and  much  carbonic  acid  and  many  microbes  exhaled 
by  the  others,  we  are  liable  to  reap  the  disadvantages  we  have 
set  forth  in  the  chapter  on  the  dangers  of  a  close  room.  Accord- 
ing to  Pettenkofer,  the  exhalations  from  the  persons  present  in  a 


264  Old  Age  Deferred. 


close  room  are  much  more  noxious  than  the  carbonic  acid  gas. 
We,  therefore,  open  the  window  and  door  in  order  to  create  a  cur- 
rent of  fresh  air,  and  so  allow  the  oxygen  to  be  renewed.  In 
this  we  but  imitate  nature,  which  sends  a  wind  to  purify  the 
close  atmosphere  on  warm  summer  days.  This  is  natural 
ventilation. 

If  we  want  to  preserve  our  youth  for  a  long  time  and  attain 
an  old  age,  we  must  take  all  available  means  to  avoid  such  air 
contaminated  by  billions  of  microbes  and  vitiated  by  the  exhala- 
tion of  so  many  human  beings  and  animals,  who  also  absorb 
much  of  the  oxygen.  To  this  is  added  the  smoke  from  the 
numerous  manufactories,  houses,  and  plants,  and  the  dust  and 
exhalations  from  many  noxious  substances  of  various  kinds.  As, 
however,  fortunately,  all  this  vitiated  air  is  generally  found  in  the 
lower  strata,  always  endeavor  to  find  a  lodging  in  the  more 
elevated  portions  of  the  city,  and  on  the  highest  floor  possible  if 
staying  in  an  apartment  house  or  in  a  hotel.  If  possible  our 
houses  should  be  built  on  the  outskirts  of  the  city,  and  preferably 
near  a  park,  or  wood,  or  at  least  a  meadow  where  there  is  a  free 
circulation  of  pure  air. 

In  our  rooms,  and  especially  in  the  sleeping  room,  the  win- 
dow, or  at  any  rate  the  transom,  should  always  stand  open, 
and  if  possible  also  during  the  night.  But  when  obliged  to  sleep 
in  a  room  with  a  closed  window  to  avoid  the  noise  of  the  street 
traffic,  the  first  thing  to  do  in  the  morning,  directly  one  gets  up, 
is  to  open  the  window  and  let  in  the  fresh  air,  and  do  not  close 
the  window  again  until  night-time.  When  we  are  well  covered 
we  need  not  be  afraid  of  catching  cold.  As  a  rule  only  those 
take  cold  who  keep  in  a  warm  room  and  live  at  enmity  with  fresh 
air.  Fresh  air,  as  a  matter  of  fact,  never  does  any  harm  to  its 
friends;  it  is  only  dangerous  to  its  enemies.  As  Captain  Svaer- 
drup,  a  member  of  Nansen's  expedition  to  the  North  Pole,  told 
us,  he  and  his  comrades  never  suffered  from  colds  as  long  as  they 
were  in  the  polar  regions.  They  first  caught  them  when  they 
approached  Christiania. 


Open  Air  Life  and  Breathing  Exercises.  265 

When  standing  at  the  window  inhale  the  fresh  air  deeply 
several  times  and  retain  it  as  long  as  possible  before  exhaling  it. 

Indeed  we  could  preserve  our  health  much  more  effectively 
if  we  imitated  the  Indian  and  slept  in  the  open  air.  It  is  a  fact 
that  many  Indians  possess  great  immunity  to  all  kinds  of 
fatigue,  enjoy  very  robust  health,  and  reach  a  green  old  age. 
This  is  undoubtedly  due  to  the  fact  that  they  pass  the  whole 
of  their  life  in  the  open  air.  When  tuberculous  people  are 
kept  under  the  free-air  treatment  we  are,  after  all,  only  follow- 
ing the  example  of  the  red  man.  Nobody  who  is  accustomed  to 
live  in  a  close  room  with  heavy  curtains  at  an  average  tem- 
perature of  750  to  8o°  from  October  to  May,  can  imagine  the 
pleasures  of  a  wooden  hut  or  tent  for  day  and  night  use.  When 
Dr.  Pottenger,  of  the  Monrovia  Sanatorium,  near  Los  Angeles, 
California,  showed  me  around  his  little  wooden  cottages  in  which 
his  patients  lived,  I  simply  envied  them.  I  cannot  imagine  a 
more  healthy  dwelling-place  than  a  tent  in  summer  and  a  wooden 
hut  in  winter,  with  a  stove  in  it  for  the  cold  weather;  and  if  we 
cannot  raise  the  heat  over  75  °,  so  much  the  better. 

The  son  of  a  family  in  England,  who  are  great  friends  of 
mine,  has  formed  a  resolution  not  to  sleep  any  longer  in  the 
comfortable  family  mansion,  but  in  a  tent  in  the  meadows  of 
his  property  during  both  winter  and  summer.  His  family  and 
friends  regarded  this  as  an  eccentricity,  against  which  they 
warned  him ;  but  still  he  got  on  very  well  in  his  tent,  and  looks 
fresher  and  healthier  than  ever  before.  We  are  always  put  down 
as  eccentric  if  we  have  the  courage  to  resist  the  foolish  preju- 
dices of  our  surroundings.  For  my  part  I  prefer  to  live  to 
be  100,  and  to  attain  this  I  do  not  object  to  be  considered 
"eccentric." 

Anyone  who  is  anxious  to  live  long  and  preserve  his  youth 
should  endeavor  to  spend  as  much  time  as  possible  in  the  open 
air.  After  the  day's  work  is  finished  we  should  always  get  out 
into  the  air,  preferably  in  a  park  or  wood  adjacent  to  our  home, 
where  there  is  more  oxygen  contained  in  the  air.     We  should 


266  Old  Age  Deferred. 


follow  the  example  of  those  English  people  who  leave  town  on 
Saturday  and  remain  in  the  country  until  Monday,  leaving  be- 
hind them  the  cares  of  business.  There  is  probably  no  nation 
which  likes  exercise  in  the  open  air  so  much  as  the  English, 
Scotch,  and  Irish,  and  among  them  is  to  be  found  the  greatest 
longevity.  An  agreeable  way  to  get  plenty  of  fresh  air  is  by 
automobiling,  and  for  those  whose  means  can  afford  it  long 
journeys  by  automobile  may  constitute  an  excellent  fresh  air 
cure,  as  they  tend  to  improve  the  appetite,  produce  sleep,  and 
relieve  neurasthenic  conditions  in  general.  But  automobiling  can 
only  be  considered  as  a  hygienic  means  for  longevity  when  the 
speed  does  not  exceed  twenty  to  twenty-five  miles  an  hour. 

When  in  the  country  we  should  always  prefer  mountains, 
and  the  higher  they  are  the  purer  is  the  air  and  the  more  oxygen 
does  it  contain,  as  a  rule.  At  the  same  time  very  much  depends 
also  on  the  presence  of  forests,  especially  of  pines  and  fir  trees. 
High  mountains  with  such  arborization  generally  have  pure 
fresh  air  full  of  oxygen,  and  there  is  no  drug  in  pharmacy 
that  can  equal  this  in  its  beneficial  effects.  It  is  a  fact,  estab- 
lished by  leading  physiologists,  that  persons  living  on  mountains 
have  more  red  blood-corpuscles  than  those  living  in  the  plains. 
When  patients  are  sent  to  spots  so  elevated  in  the  air  as  moun- 
tains with  forests,  we  find  them,  as  a  rule,  looking  healthy 
and  fresh  when  they  return  from  their  holiday  in  the  fresh  air. 

As  found  by  A.  and  Y.  Loewy  and  Luntz,1  mountain  air 
improves  the  processes  of  oxidation  and  increases  the  number 
and  depth  of  the  respirations.  All  this,  however,  according  to 
these  savants,  is  the  result  of  the  exciting  action  of  the  sunshine. 
It  speaks  volumes  for  the  health-giving  properties  of  moun- 
tain air  that  the  inhabitants  of  such  spots,  especially  in  Scotland, 
Switzerland,  and  Norway,  have  such  fresh  rosy  cheeks.  These 
we  notice  more  particularly  among  the  females,  especially  in 
young  girls  who  are  freer  from  the  agencies  harmful  to  good 


l  Quoted  after  Landois :     "Lehrbuch  der  Physiologie  des  Menschen,"  Berlin, 
Wien,  1905,  eleventh  edition,  p.  235. 


Open  Air  Life  and  Breathing  Exercises.  207 

health,  such  as  alcohol,  sexual  excesses,  etc.  In  Norway  almost 
all  the  young  girls  have  fresh  red  cheeks,  for  which,  indeed, 
they  are  noted,  due  to  the  delightful  air  on  its  mountains  and 
forests,  with  which  the  whole  land  is  almost  covered. 

I  had  the  opportunity  of  proving  for  myself,  after  spending 
a  certain  time  in  a  resort  on  the  top  of  a  mountain  in  Norway,  the 
delightful  purity  and  invigorating  quality  of  the  air,  which  was 
due  to  the  large  amount  of  oxygen.  As  a  confrere  expressed  it, 
there  was  champagne  in  the  air !  It  was  not  soiled  here  by  any 
manufacturing  plant,  the  curse  of  so  many  places  with  fine  air. 
Norway,  one  of  the  most  extensive  countries  in  Europe,  has  at  the 
same  time  a  very  small  population,  only  about  two  millions,  and 
very  few  factories,  so  that  the  air  is  not  polluted  either  by  a 
dense  population  or  by  the  smoke  of  manufactories.  Scotland, 
with  its  highlands,  has  also  a  similar  air,  and  the  color  of  the 
Scotch  lassies  is  not  far  behind  their  Norwegian  sisters.  This 
can  be  admitted  as  a  scientific  argument  for  the  relations  of 
health  in  the  country. 

But  Americans  need  not  travel  so  far.  There  is  as  good  a 
climate  and  wonderfully  fresh  air  in  the  Rocky  Mountains,  and 
also  in  other  highly  elevated  places,  of  which  America  can  boast 
many  more  than  Europe.  But  whether  there  or  in  Europe  it 
would  be  necessary  to  give  up  all  occupations  for  a  few  months, 
or  at  least  for  several  weeks  after  every  six  months.  This  time 
we  should  pass  in  those  elevated  places  where  we  can  climb  every 
clay;  climbing  presents  an  excellent  opportunity  to  get  much 
fresh  air  into  our  lungs,  as  we  are  then  obliged  to  take  much 
deeper  inspirations,  thereby  obtaining  more  oxygen  from  the 
pure  air  of  the  mountains.  As  we  shall  show  in  the  next  chapter, 
exercise  combined  with  fresh  air  is  of  the  greatest  importance 
to  our  health  and  chances  for  a  long  life  and  a  green  old  age. 

But  in  order  to  get  plenty  of  air  it  is  not  indispensable  to  go 
to  forests  or  mountains  or  to  the  seaside;  we  can  also  get  it  at 
home,  although  not  with  the  same  amount  of  oxygen.  To 
absorb   much   air  we   must   breathe   deeply   and   keep   in  the 


268  Old  Age  Deferred. 


inspired  air,  and  endeavor  to  get  it  into  all  parts  of  the  lungs. 
In  ordinary  life  we  forget  this  and  we  get  just  as  much  air 
into  us  with  our  superficial  breathing  as  is  necessary  to  keep  us 
alive  and  to  feel  no  harm  from  our  want  of  air.  Most  people 
breathe  only  superficially,  and  only  inspire  deeper  when  mounting 
the  staircase,  unless,  indeed,  they  adopt  the  less  healthy  habit  of 
reaching  the  first  floor  by  the  elevator.  But  as  it  is  of  apparent 
benefit  to  us  to  get  as  much  air  into  our  lungs  as  possible,  we  im- 
prove this  state  of  affairs  by  breathing  exercises.  The  great  im- 
portance of  these  breathing  exercises  for  the  prolongation  of 
human  life  has  been  especially  insisted  on  by  Sir  Herman  Weber.2 
But  before  him,  Hamel  and  Harry  Campbell3  had  already  demon- 
strated the  great  therapeutic  results  of  respiratory  exercises. 
Sir  Herman  Weber  recommends  commencing  with  moderately 
deep  inspirations  and  expirations,  continued  during  from  three  to 
five  minutes  once  or  twice  a  day,  and  then  gradually  increasing  to 
ten  minutes  or  a  quarter  of  an  hour.  The  depth  of  each  inspira- 
tion and  expiration,  and  the  duration  of  holding  the  breath,  are 
to  be  increased  only  gradually.  Sir  Herman  Weber  advises  in- 
spiring in  an  erect  position,  with  raised  arms  and  closed  mouth, 
bending  the  body  forward  during  expiration  so  that  the  fingers 
touch  the  ground  or  the  toes. 

According  to  this  authority,  besides  the  influence  on  the  cir- 
culation, the  respiratory  movements  keep  up  the  nutrition  and 
efficiency  of  the  lungs,  and  also  maintain  the  elasticity  of  the 
chest  walls,  which  are  apt  to  become  stiff  in  old  age  and  thus 
interfere  with  the  free  action  of  the  lungs  and  pleura. 

These  respiratory  exercises  can  also  be  performed  in  a 
sitting  or  horizontal  position. 

According  to  Sir  Lauder  Brunton,  the  deep  respiratory 
movements  act  as  a  kind  of  massage  to  the  lungs,  thoracic 
walls,  pericardium,  and  heart. 

Sir  Herman  Weber  mentions  that  he  has  seen  persons  who 

2Loc.  cit. 

3  Dr.  Harry  Campbell  on  "Bespiratory  Exercise  in  the  Treatment  of  Disease," 
Jxmdon,  1907. 


Open  Air  Life  and  Breathing  Exercises.  2uy 

get  out  of  breath,  even  after  short  walks  and  climbs,  and  who 
for  this  reason  abstained  from  such,  and  consequently  suffered 
in  health  and  spirits,  become,  by  means  of  these  movements, 
active  walkers  and  climbers,  gaining  improvement  in  every 
function  of  the  body,  and  outliving  by  many  years  their 
brothers  and  sisters  who  had  not  practiced  them.  He  also  spe- 
cially recommends  these  breathing  exercises  to  literary  workers, 
statesmen,  professional  men,  and  others  who  get  no  time  to  take 
the  usual  methods  of  exercise. 

In  certain  heart  troubles — for  example,  dilatation  of  the 
heart — these  movements  are  contraindicated. 

It  is  natural  that  if  we  practice  these  exercises  in  the 
fresh  air  of  the  forests  or  mountains  their  salutary  action  will 
be  still  more  pronounced.  But  if  we  are  too  indolent  to  per- 
form the  regular  breathing  exercises,  whose  beneficial  effect  upon 
the  heart's  nutrition  and  action  is  so  great,  it  will  suffice  for 
us  to  take  deep  inspirations  and  expirations  while  walking.  We 
must  get  into  the  habit  of  doing  this  every  day,  and  thus  prolong 
our  life. 

As  a  general  rule  we  only  breathe  with  one  part  of  our 
lungs,  sadly  neglecting  the  other,  by  which  the  aeration  of  the 
blood  will  not  be  so  thorough.  Independently  even  of  the  breath- 
ing exercises,  it  would  be  very  advantageous  to  our  health  if  we 
gently  took  a  long  breath,  which  should  be  so  prolonged  that  we 
feel  our  stomach  distended.  The  air  will  thus  reach  the  deeper 
portions  of  our  lungs.  This  will  also  be  the  best  practice  while 
singing;  indeed,  the  latter  would  be  the  very  best  of  ways  in 
which  to  obtain  a  good  and  thorough  aeration  of  the  lungs. 
We  have  heard  of  cases  where  people  without  a  voice  have 
taken  singing  lessons,  for  the  simple  reason  that  they  were 
descended  from  families  in  which  tuberculosis  was  hereditary. 

This  latter  disease  is  one  of  the  most  frequent  causes  of  a 
shortened  existence,  and  it  is,  therefore,  our  duty  to  point  out 
here  the  great  advantages  not  only  of  a  generous  diet,  consisting 
of  a  certain  amount  of  underdone  fresh  meat,  uncooked  milk 


270  Old  Age  Deferred. 


of  healthy  cows  or  goats,  and  many  eggs,  sausages  and  puddings 
made  of  the  blood  of  pigs  (see  Chapter  XXXIX),  but  also  of 
regular  deep  breathing,  thereby  permitting  of  the  entry  of  oxygen 
to  all  parts  of  the  lungs. 

We  always  recommend  breathing  through  the  nose,  as 
doing  so  through  the  mouth  dries  up  the  mucous  membranes, 
especially  if  throughout  the  night,  during  sleep,  the  mouth  is 
kept  open.  This  bad  habit  permits  of  the  entrance  of  cold  air 
which,  not  being  warmed  by  passing  through  the  nasal  passages, 
may  be  injurious  to  the  lungs.  The  Indians  are  fully  cognizant 
of  this  fact,  for  in  some  tribes  the  mother  binds  up  the  mouth 
of  her  child  and  thus  compels  it  to  breathe  through  the  nose. 

In  the  foregoing  we  have  shown  the  great  advantages  of 
abundant  fresh  air.  We  have  referred  to  the  fresh  appearance 
of  country  people,  especially  of  those  who  live  on  mountains,  as 
also  to  the  improved  condition  of  tuberculous  persons  after  having 
been  exposed  to  as  much  fresh  air  as  possible.  I  ask,  therefore, 
why,  if  people  suffering  from  this  disease  derive  so  much  bene- 
fit from  fresh  air,  should  not  we,  who  are  still  healthy,  be  also 
benefited  by  it  ?  Let  us  therefore  remain  in  the  open  air  as  much 
as  possible,  and  never  prevent  its  close  approach  to  us;  for  it 
gives  health,  long  youth,  and  a  good  old  age. 


CHAPTER   XXXII. 

On  the  Dangers  of  Living  in  Confined  and  III 
Ventilated  Quarters. 

Persons  in  the  enjoyment  of  complete  health  and  vigor  are 
frequently  very  sensitive  to  recognize  the  different  agencies 
deleterious  to  their  health.  In  the  same  way  as  animals  they 
possess  a  certain  instinct  in  this  respect.  In  fact  it  is  by  this 
faculty  alone  that  they  can  enjoy  a  normal  and  robust  health, 
as  they  are  thus  enabled  to  avoid  all  kinds  of  dangers  to  their 
health,  the  integrity  of  their  healthy  mind  also  giving  them  the 
necessary  will  power  for  this  purpose. 

Against  all  sorts  of  dangers  to  their  health  such  persons,  as 
a  rule,  are  prompt  to  act ;  thus,  when  they  come  into  a  close 
room  the  air  will  soon  become  offensive  to  them,  and  they  will 
either  leave  or  ask  for  the  opening  of  a  window  or  of  a  venti- 
lator, closed  through  folly.  On  the  other  hand  sickly  persons, 
or  people  who  do  not  otherwise  enjoy  perfect  health  or  well- 
balanced  minds,  will  remain  in  such  a  vicious  air  and  contract  all 
the  dangers  consequent  to  it,  shortening  their  prospects  for  a 
healthy  youth  and  long  life. 

That  living  in  the  vitiated  air  of  a  close  room  is  deleterious 
to  health  is  proved  by  a  simple  observation  of  the  faces  of  those 
stopping  for  a  long  time,  or  habitually  doing  so  by  reason  of 
their  professions,  in  close  localities.  They  will  present  a  pale, 
gray  sickly  appearance,  and  it  is  a  fact  that  they  very  rapidly 
acquire  all  sorts  of  infections;  especially  is  tuberculosis  very 
prevalent  in  such  cases.  We  observe  precisely  the  same  thing 
in  the  case  of  plants  which,  if  kept  in  a  close  room,  especially 
where  little  light  reaches  them,  soon  lose  their  color  and  are 
destroyed  by  parasites ;  and  exactly  the  same  happens  in  the  case 
of  man.     Prisoners,  unfortunate  work-people,  living  and  labor- 

(271) 


272  Old  Age  Deferred. 


ing  in  large  numbers  in  small  and  close  quarters,  waiters  and 
similar  employees,  are  those  in  whom  tuberculosis  is  most  fre- 
quently found.  In  respect  to  workmen,  this  may  be  more  truly 
the  case  in  Europe,  where  they  live  under  more  miserable  condi- 
tions, than  in  America,  where  their  position  is  possibly  the  most 
enviable  of  all  wage  earners. 

Close  air,  just  as  much  as  stagnant  water,  promotes  the 
growth  of  dangerous  microbes,  and  the  chances  of  infection  are 
greatly  enhanced  where  a  number  of  people  are  gathered  together 
in  such  places.  Many  of  them  may  be  suffering  from  infectious 
diseases  of  the  respiratory  organs ;  they  exhale,  and  also  eject  by 
coughing  or  sneezing,  an  enormous  number  of  microbes,  which 
mingle  with  the  air  and  multiply  at  their  leisure  in  such  close 
atmospheres;  and  this  is  especially  so  when  they  are  assisted  in 
their  growth  by  the  great  heat  prevalent  in  such  places,  par- 
ticularly in  winter  time.  Bacteriological  examinations  made  of 
the  air  of  such  localities  have  shown  an  enormous  number  of 
dangerous  microbes.  We  need,  therefore,  not  be  surprised  when 
persons,  and  especially  children  whose  resistance  is  diminished, 
often  contract  tonsillitis,  diphtheria,  bronchitis,  or  pneumonia, 
etc.,  after  having  passed  an  evening  in  such  a  place,  the  air  being 
hot,  and  particularly  if,  at  the  same  time,  the  temperature  outside 
was  very  low. 

Living  in  a  close  room  will  soon  tell  on  the  general  health, 
and  this  is  easily  visible  in  the  appearance  of  such  persons. 
Their  pale  faces  form  a  striking  contrast  to  the  fresh  rosy  cheeks 
of  those  who  habitually  live  in  the  fresh  air.  Those  who  have 
to  pass  their  lives  in  offices  are  to  be  pitied,  although,  to  a  large 
extent,  it  is  their  own  fault;  they  deprive  themselves  of  the 
benefit  of  fresh  air,  which,  after  office  hours,  they  would  have 
ample  opportunity  to  obtain  if  they  would  not  persist  in  spending 
their  leisure  time  in  a  club  or  other  close  place,  instead  of  taking 
a  brisk  walk  and  exercise  in  the  fresh  air.  No  wonder  that 
such  people  easily  acquire  dyspepsia  and  stomach  troubles! 
Exercise  in  the  open  air  is  most  valuable  for  promoting  an 


Confined  and  Ill-ventilated  Quarters.  273 


appetite,  and  persons  sitting  constantly  in  close  places  often  lack 
this;  thus  their  gastric  juice,  which  is  indispensable  to  a  thorough 
digestion  (see  chapter  on  hygiene  of  eating— how  to  obtain  an 
appetite)  fails,  and  eating  without  this  juice  their  food  will  not 
be  well  digested  and  will  create  stomach  troubles,  which  are  ex- 
tremely frequent  in  such  office  workers,  but  rarer  in  the  case  of 
peasants,  coachmen,  and  other  fortunate  individuals  whose  occu- 
pation keeps  them  in  the  fresh  open  air.  There  is  an  increased 
amount  of  carbonic  acid  in  the  air  of  all  localities  where  many 
persons  are  present.  According  to  Pettenkofer,  even  in  our 
living-rooms  the  carbonic  acid  content  of  the  air  is  increased 
above  the  normal;  and  still  more  is  this  so  in  lecture-halls  (3.2 
per  cent.,  against  a  normal  content  of  0.5  per  cent.),  in  public 
houses  (4.9  per  cent.),  and  most  of  all  in  school  rooms  (7.2  per 
cent. ) . 

We  should,  therefore,  always  keep  a  window  open  and  never 
close  the  ventilator.  Fresh  air  is  the  thing  we  are  most  in  need 
of  to  carry  on  the  oxidizing  processes  in  our  body.  Exclude 
this  and  you  exclude  health.  We  must  also  remove  from  the 
rooms  all  those  things  which  can  absorb  the  air  or  hinder  its 
entrance.  There  should  never  be  flowers,  and  particularly  no 
potted  plants,  in  a  living  room,  as  they  require  air  like  ourselves ; 
while  to  sleep  in  a  room  with  plants  is  very  deleterious  (see 
chapter  on  sleep). 

Curtains  should  all  be  removed,  especially  those  of  a  heavy 
nature  and  dark  color,  which  would  prevent  the  entrance  of  the 
beneficial  sunshine.  Every  room  should  be  provided  with  open- 
ings for  ventilation,  and  the  transoms  used  in  America  are  espe- 
cially useful  when  they  are  open,  and  not  used  only  to  let  the 
electric  light  into  the  sleeping  room  during  the  night,  thus  dis- 
turbing sleep.  As  a  close  room  tends  to  shorten  life  it  should  be 
the  policy  of  the  government  authorities  never  to  allow  the  use 
of  any  newly  built  house,  especially  of  public  buildings,  unless  it 
contains  openings  for  ventilation,  the  closing  of  which  should  be 
very  severely  punished  by  law. 


274  Old  Age  Deferred. 


If,  during  the  day,  it  is  necessary  to  have  fresh  air  in  every 
room,  there  is  still  greater  necessity  for  this  during  the  night, 
as  we  require  more  air  during  sleep  than  while  awake;  and, 
therefore,  we  should  never  sleep  in  a  room  that  is  entirely 
closed,  but  always  leave  the  window  (the  upper  part  by  prefer- 
ence) or  the  ventilator  open. 

We  can  easily  convince  ourselves  how  injurious  it  is  to 
sleep  in  a  close  room  by  leaving  our  room  in  the  morning,  taking 
a  walk  in  the  fresh  air,  and  then  re-entering  our  sleeping  cham- 
bers that  have  remained  closed  as  we  left  them,  and  we  shall  at 
once  realize  the  unhealthy  condition  of  the  air  in  such  a  room, 
filled  as  it  is  with  carbonic  acid  that  has  been  exhaled  during  the 
night,  and  also  loaded  with  the  other  deleterious  toxic  substances 
cast  off  by  our  lungs  and  skin.  We  shall  then  certainly  make  up 
our  minds  not  to  inhale  during  the  next  night  the  same  air  again, 
but  to  allow  it  to  escape  by  the  open  window  and  thus  permit 
the  entrance  of  fresh  air  into  our  lungs,  whose  need  for  air  is 
much  increased  during  sleep  in  order  to  replace  the  large  volume 
of  carbonic  acid  exhaled. 

As  a  consequence  of  passing  the  night  in  such  a  close  room, 
we  feel,  on  the  following  morning,  very  heavy,  and  often  have  a 
headache;  we  also  often  have  no  appetite  for  breakfast  after 
such  a  night,  unless  we  first  take  a  walk  in  the  fresh  morning 
air. 

The  danger  of  the  close  room  should  be  brought  home  to 
all,  even  children,  through  instruction  in  hygiene  in  the  pub- 
lic schools ;  and  even  from  their  very  youngest  days  this 
should  be  instilled  into  the  minds  of  youth,  together  with  the 
contra-advantages  of  fresh  air.  By  these  means  they  will  be 
accustomed  to  the  fresh  air  and  its  beneficial  effects,  as  much 
as  they  will  learn  to  detest  the  horrors  of  the  air  exhaled  by 
other  people,  which  is  the  source  of  so  many  infections.  Every 
one  who  wishes  to  enjoy  life  during  youth,  and  live  to  a  good  old 
age,  should  abominate  a  close  room  and  never,  if  he  can  possibly 
help  it,  pass  an  hour  in  such  an  atmosphere. 


CHAPTER   XXXIII. 

Hygiene  of  Artificial  Heating — the  Dangers  of  Heat  by 
Steam  and  a  Few  Hints  about  their  Prevention. 

Old  people  are  particularly  sensitive  to  cold,  and  they  there- 
fore need  a  warm  room  when  the  temperature  falls  in  the 
autumn.  In  old  age,  especially  in  its  advanced  stage,  the  pro- 
cesses of  oxidation  are  diminished,  and  thus  less  natural  warmth 
is  produced ;  but,  as  we  give  off  more  heat  in  cold  weather,  it  is 
only  natural  that  they  will  feel  the  cold  then  much  more  than 
younger  individuals. 

The  rooms,  therefore,  in  which  old  people  live  must  be 
kept  very  warm,  in  the  same  manner  as  we  do  with  infants, 
especially  for  those  who  come  of  parents  with  degenerated 
thyroids.  Thus  we  see  again  how  old  age  and  infancy  present 
many  parallel  features. 

But,  if  a  very  warm  room  be  compulsory  for  aged  folks, 
no  such  necessity  exists  in  the  case  of  the  young  or  middle  aged, 
and  it  is  abusing  their  health  if  they  remain  long  in  rooms  heated 
above  750  to  850,  or  sometimes  900,  where,  at  the  same  time, 
every  window  is  sedulously  closed  on  all  sides,  so  that  no  fresh 
air  can  find  entrance.  Such  overheated  rooms  we  usually  find 
in  northern  climates,  and  the  air  in  such  cases  is  frequently 
hotter  in  the  house  in  winter  than  we  find  it  in  the  open  on  a  com- 
fortably warm  summer  day,  when,  being  in  the  open,  the  heat 
can  certainly  be  better  borne  than  in  a  close  room. 

In  America  many  things  are  better  than  in  Europe ;  but  this 
certainly  does  not  apply  to  the  method  of  heating  used  in  the  ma- 
jority of  the  houses,  hotels,  and  office  buildings,  all  of  which 
are  mostly  overheated,  and  that  by  steam  heat,  and  very  fre- 
quently with  defective  ventilation,  if  there  be  any  at  all.  The 
worst  part  of  it  is  that  a  uniform  heat  is  maintained,  whether 

(275) 


276  Old  Age  Deferred. 


it  be  a  warm  or  a  cold  day;  thus,  the  air  temperature  was 
550  F.  on  October  15,  1906,  when  I  was  in  New  York,  and  in 
one  of  the  most  fashionable  hotels  the  temperature  was  75  °  F. 
In  Houston,  Texas,  there  was  a  heat  wave  in  February,  1907, 
with  disagreeable  hot  weather,  yet  700  F.  of  steam-generated 
heat  was  maintained  in  the  hotels,  which  made  life  unbearable  for 
those  who,  like  the  author  of  this  book,  are  so  fond  of  fresh  air. 

As  we  are  endeavoring  in  this  work  to  give  hints  how  to 
reach  a  ripe  old  age  and  prevent  diseases  which  may  dissipate  our 
hopes  in  that  direction,  it  is  our  duty  to  protest  and  to  point  out 
the  dangers  of  such  irrational  heating. 

It  seems  to  me,  however,  that  in  some  northern  countries 
in  Europe  things  are  not  much  better,  especially  since  steam 
heat  is  becoming  more  and  more  used,  as  in  Norway,  even 
in  the  private  houses.  In  some  of  these  countries — Russia,  for 
instance — cotton  is  put  around  the  window  panes  to  exclude  the 
air,  and  also  to  absorb  the  moisture  condensed  on  the  inside  of 
the  double   windows. 

In  many  European  countries,  however,  fireplaces  and  stoves 
are  common.  The  most  rational  method  of  heating,  though  not 
the  most  economical,  is  the  open  fireplace  in  England,  whence  the 
most  ventilation  is  obtained;  for  the  essence  of  the  problem  is 
to  obtain  warmth  and  fresh  air  at  the  same  time.  English, 
Scotch,  and  Irish  are  most  sensitive  to  an  overheated  room,  and 
they  are  probably  the  most  healthy  inhabitants  of  Europe,  too. 
While  a  guest,  some  years  ago,  of  friends  in  Derbyshire,  I  well 
remember  that,  directly  the  temperature  rose  above  65,  the  win- 
dows were  thrown  open. 

Americans  in  Europe  often  complain  that  they  are  not 
warmed  at  the  fireplace,  which  only  keeps  the  face  and  not  the 
body  warm.  This,  however,  will  only  apply  to  those  who 
only  feel  comfortable  at  a  temperature  of  75 °  F.,  which  is  dis- 
tinctly unhealthy ;  for  the  open  English  grate  can  very  easily 
produce  the  standard  temperature  of  150  R.  (about  180  C), 
which  should  not  be  exceeded  if  we  want  to  have  a  healthy 


Hygiene  of  Artificial  Heating.  217 

warmed  atmosphere  in  our  rooms.  Of  course  such  fireplaces 
can  produce  a  much  higher  temperature,  but  even  then  the  air 
is  never  so  offensive  as  that  of  rooms  heated  by  steam. 

It  would  seem,  at  first  thought,  that  women  can  withstand 
cold  much  better  than  men,  considering  how  much  lighter  is 
their  dress  and  how  much  more  it  exposes  them  to  cold  air.  We 
sometimes  see  young  girls  of  the  poorer  class  in  such  light  cloth- 
ing in  mid-winter,  standing  in  the  streets  and  talking  with  their 
friends,  that  we  men  shiver  at  the  mere  idea  of  such  clothing. 
Yet  it  is  women  who  most  need  a  warm  room,  probably  because 
their  dress  is  much  the  same  indoors  in  mid-winter  as  in  mid- 
summer. They,  however,  when  out-of-doors  wear  heavy  furs 
which  entirely  check  the  respiration  of  their  skin;  and  their 
light  clothes,  when  indoors,  do  not  afford  much  opportunity  for 
their  skin  respiration,  for  then  there  is  usually  no  fresh  air  in  the 
house,  but  an  oppressive  heat,  all  air  ventilators  being  sedulously 
closed.  It  is  strange  how  people  try,  by  every  means,  to  destroy 
their  health ! 

In  warm  weather  we  give  off  less  warmth  and  do  not 
require  so  much  food  in  order  to  produce  warmth,  as  the  natural 
temperature  also  requires  less  of  us;  in  summer,  therefore,  we 
need  less  nourishment. 

Circumstances,  also,  become  much  more  equalized  in  the 
artificial  summer  of  the  overheated  room.  Whereas  people  tak- 
ing a  brisk  walk  in  a  cold  and  bracing  atmosphere  return  with 
rosy  cheeks  and  a  roaring  appetite,  the  unfortunates  who  per- 
sist in  passing  the  day  in  overheated,  especially  steam-heated 
places  with  a  confined  atmosphere  will  not  feel  a  natural  hunger, 
will  eat  without  a  healthy  appetite,  and  will  have  insufficient 
gastric  juice  (see  chapter  on  appetite),  exposing  themselves  to 
digestive  troubles  in  consequence.  Their  need  for  food  will  be 
less,  and  a  bad  condition  of  health  will  follow. 

Another  and  most  imminent  danger  of  overheated  rooms 
is  the  facility  with  which  we  are  apt  to  take  cold  by  walking  from 
a  room  kept  at  summer  heat  to  the  outside  cold  of  winter.     We 


278  Old  Age  Deferred. 


all  know  how  we  catch  cold,  as  a  rule,  but  we  never  know  how 
it  may  end.  Sometimes  a  simple  cold  is  followed  by  sore  throat, 
but  often  also  by  catarrh  of  the  bronchi,  and  even  of  the  lungs. 
In  persons  addicted  to  alcohol  a  fatal  pneumonia  from  such  a 
cause  is  common ;  but,  in  any  event,  there  is  a  great  failing  of  the 
general  health  for  a  long  time,  all  of  which  may  have  originated 
from  an  overheated  room  which  has  made  us  more  sensitive  to 
the  effects  of  cold. 

When  we  keep  ourselves  cool  we  are  less  liable  to  catch 
cold,  as  is  well  known;  for  then  our  body  is  not  first  heated  up 
and  then  cooled  off  rapidly.  This  has  been  shown  by  experiments 
on  animals.  It  is  certain  that  people  accustomed  to  a  temperature 
of  1 50  R.  have  much  less  tendency  to  take  cold  than  those  living 
in  rooms  at  75  °  to  900  F.  Such  a  temperature  is  also  a  breeding 
place  for  billions  of  dangerous  microbes,  which  certainly  prosper 
better  at  such  a  warm  temperature. 

Still  more  dangerous  are  the  consequences  from  the  over- 
heating of  railway  compartments,  as  then  it  is  still  less  impossible 
to  avoid  rapid  changes  of  temperature.  When  there  are  many 
persons  in  overheated  places,  and  the  exhaled  air  from  all  of 
them  contains  an  enormous  quantity  of  virulent  bacilli,  the  dan- 
ger of  infection  is  still  greater ;  especially  so  when  there  is  steam- 
generated  heat,  with  its  injurious  effects  on  the  mucous  mem- 
branes, whose  resistance  to  bacillary  invasion  is  thus  lowered. 

Steam  heat  is  the  most  injurious  of  all  heat,  as  it  dries  up 
the  mucous  membranes  and  renders  them  thereby  more  liable  to 
infection.  We  have  often  noticed  in  persons  with  large  tonsils 
inflammation  of  these  glands,  which  commenced  every  time  that 
such  persons  inhaled  steam-generated  heat  for  several  hours. 
Such  frequent  tonsillitis  will  also  undermine  the  health,  espe- 
cially if  we  consider  that  not  infrequently  an  acute  glomerulo- 
nephritis may  ensue  (and  often  does  follow,  in  an  insidious  way, 
without  even  being  diagnosed).  There  have  also  been  plenty  of 
cases  of  appendicitis  in  which  the  tonsillitis  has  been  in  prior 
etiological  relation  to  its  development. 


Hygiene  of  Artificial  Heating.  279 

We  have  observed  persons  who,  in  consequence  of  such  fre- 
quent tonsillitis  clue  to  steam  heat,  have  run  clown  in  health,  lost 
their  appetite,  and  presented  a  pale,  gray  and  miserable  appear- 
ance, whereas  before  they  were  rosy-cheeked  and  vigorous.  In 
others,  continued  pharyngitis,  bronchitis,  and  sometimes  asthma, 
may  be  observed. 

In  order  to  mitigate  these  dangers  of  steam  heat  we  must 
place  basins  filled  with  hot  water  in  the  localities  where  the  steam 
heat  is  produced.  Such  basins  can  be  readily  placed  behind  and 
attached  to  the  radiators ;  but  they  must  be  of  large  dimensions 
and  must  be  kept  properly  filled. 

Steam  heat  is  most  dangerous  when  there  is  insufficient 
ventilation ;  there  should,  therefore,  be  behind  the  radiators,  and 
also  in  the  opposite  wall  at  a  certain  height,  an  opening  for  ven- 
tilation. It  is,  of  course,  understood  that  such  ventilators  are 
to  be  always  kept  open  and  not,  as  is  unhappily  so  often  the  case, 
closed.  It  is  of  the  utmost  importance  that  the  radiators  be 
thoroughly  dusted  every  day,  as  this  heated  dust  is  most  injurious 
to  health.  This  is  a  rule  that  should  be  especially  observed  in 
railway  cars. 

Fireplaces  and  stoves,  which  allow  of  a  renovation  of  the 
air  in  a  room,  are  superior  to  the  steam  heat.  In  a  room  with 
an  open  fireplace  or  a  good  stove  the  air  is  renewed,  for  a  current 
of  air  is  created  which  removes  from  the  room  microbes  and  dust. 
Thus  the  air  is  purified.  But  it  is  quite  different  with  steam  heat, 
which  does  not  remove  bad  air  from  the  room.  Fancy,  now,  a 
steam-heated  hall,  with  many  people  in  it,  which  is  overheated  at 
the  same  time,  and  you  will  understand  the  frequency  of  tonsillitis 
and  bad  colds  after  staying  in  such  a  hall — which  we  would  feel 
inclined  to  spell  in  a  different  way,  to  show  better  its  real  nature. 

Hot-water  heating  is  superior  to  steam  heating. 

Everyone  who  desires  to  preserve  youth  for  a  long  time 
and  attain  a  good  old  age,  should  avoid  living  continually  in 
places  overheated  by  steam,  without  proper  ventilation,  as  this 
is  one  of  the  surest  means  of  shortening  life. 


CHAPTER   XXXIV. 
Food  Hygiene — General  Remarks. 

The  leading  principle  in  the  use  of  food  is  that  we  should 
eat  to  live,  but  not  live  to  eat.  It  is  certain  that  more  people 
die  from  eating  too  much  than  too  little.  It  is  wonderful  to 
consider  how  little  food  animals,  or  human  beings,  can  exist 
upon  for  a  long  time  and  remain  in  good  health ;  and  it  is  certain 
that  the  foundations  of  many  diseases  are  laid  by  excessive  eating. 
It  must  be  borne  in  mind  that  the  elaboration  and  assimilation  of 
a  large  quantity  of  food  requires  the  activity,  or  even  hyperac- 
tivity, of  several  of  our  most  important  organs,  upon  the  condi- 
tion of  which  our  length  of  life  depends.  And  here  we  may 
repeat  the  statement  that  has  been  made  so  often  in  the  course  of 
this  book,  that  overactivity  of  an  organ  may  be  followed  by  its 
exhaustion.  By  laying  too  great  a  burden  upon  an  organ,  and 
continually  overworking  it  without  giving  it  any  rest  for  recuper- 
ation, we  are  burning  the  candle  at  both  ends,  and  rapidly  ex- 
hausting the  vitality  of  such  important  organs  as  the  liver, 
kidneys,  pancreas,  stomach,  and  intestines,  not  forgetting  those 
important  glands,  the  thyroid  and  parathyroid,  which  take  a  great 
share  in  the  destruction  of  poisonous  products  formed  in  our 
bodies  from  the  end-products  of  food. 

We  have  just  mentioned  that  with  very  little  food  animals, 
or  human  beings,  can  live  for  a  long  time.  But  prolonged  under- 
feeding may  be  quite  as  dangerous  as  overfeeding.  In  starva- 
tion the  resistance  against  infectious  diseases,  and  especially 
tuberculosis,  is  diminished.  This  disease,  the  most  common  of 
all  maladies,  is  found  most  often  in  underfed  people,  especially 
if  they  live  in  confined  localities  with  little  air  and  no  sunshine. 
Moderation  in  food,  as  in  everything  else,  is  the  only  way  to 
attain  a  happy  old  age. 
(280) 


Food  Hygiene.  281 

The  Romans  had  a  very  appropriate  proverb  which  ran : 
"Omne  quod  est  nimium,  vertitur  in  vitium,"  "Everything  in 
excess  becomes  a  vice." 

Much  depends  upon  the  quality  of  the  food  we  take,  for 
some  foods  are  of  very  little  nutritive  value;  and  even  of  the 
most  nutritive  food,  some  parts  may  pass  out  as  waste  products, 
because  those  organs  which  elaborate  and  assimilate  food  may  be 
partially,  or  wholly,  changed  by  disease,  and  so  unable  to  fulfill 
the  work  for  which  they  are  destined. 

Therefore,  given  a  moderate  amount  of  food,  the  condition 
of  the  body  and  the  maintenance  of  strength  will  depend  mainly 
upon  the  nutritive  value  of  that  food.  An  exact  method  of 
estimating  the  nutritive  value  of  food  has  been  shown  by  Frank- 
land,  Stohmann,  Danilewsky,  and  Rubner. 

The  best  method  of  calculating  the  nutritive  value  of  any 
food  consists  in  estimating  how  many  calories  it  produces  in 
the  body  during  combustion.  One  calorie  is  the  amount  of  heat 
necessary  to  raise  the  temperature  of  one  gramme  of  water  one 
degree  Centigrade.  Comparing  our  system  to  an  oven  in  which 
food  represents  the  fuel :  Just  as  oxygen  is  necessary  for  combus- 
tion in  the  oven,  so  we  could  not  carry  out  the  processes  of  com- 
bustion in  our  system  without  a  plentiful  supply  of  oxygen 
through  our  lungs  and  skin.  Also,  just  as  gases  produced  in  a 
furnace  must  have  free  exit,  so  the  carbonic  acid,  formed  in  our 
tissues  in  the  processes  of  combustion,  must  be  eliminated  by  the 
lungs  and  skin,  otherwise  auto-intoxication  will  occur.  The 
above-named  authorities  have  reckoned  exactly  how  many  calories 
the  various  kinds  of  food  produce  in  our  body. 

All  articles  of  diet  can  be  classified  into  three  principal 
groups :  proteids,  carbohydrates,  and  fats.  According  to  the 
abovenamed  authorities  one  gramme1  of  proteid  produces  4.1 
calories ;  one  gramme  of  carbohydrates,  4. 1  calories ;  but  one 
gramme  of  fat  produces  more  than  twice  as  many,  i.e.,  9.3 
calories. 


1  As  well  known,  one  gramme  is  the  equivalent  of  15  grains. 


282  Old  Age  Deferred. 


In  order  to  maintain  life  without  waste  or  without  exposing 
ourselves  to  disease,  it  is  necessary  to  use  all  three  kinds  of  food ; 
for  although  many  animals,  or  human  beings,  can  live  for  a  cer- 
tain time  on  only  one  variety  of  food,  most  of  them  would  die 
if  this  were  persisted  in  for  a  long  time.  The  total  exclusion 
of  proteids  especially  would  produce,  after  a  certain  time,  a  con- 
siderable wasting  of  the  body  tissues  and  certain  death.  Accord- 
ing to  Voith,  it  is  necessary  to  take  about  ioo  grammes  of  albu- 
min a  day  if  we  want  to  avoid  waste  of  body  tissue.  Proteid 
food  cannot  be  replaced  by  either  of  the  other  two  groups  of 
food. 

There  are  a  series  of  facts  which  show  that  the  estimate 
given  by  Voith  is  perhaps  too  high.  Horace  Fletcher  has  shown 
by  experiments  on  himself,  controlled  by  Professor  Chitten- 
den, that  he  could  live  in  splendid  health  with  food  not  contain- 
ing more  than  45  grammes  albumin,  and  of  1600  calories  heat 
value,  in  twenty-four  hours,  with  a  body  weight  of  186  pounds. 

As  shown  by  Professor  Noorden,2  in  Vienna,  a  man  must 
take  30  to  34  calories  for  each  kilo  (21/5  pounds)  of  his  body- 
weight  when  he  is  doing  no  work,  and  34  to  40  calories  with  light, 
and  40  to  60  calories  with  harder  work.  Accordingly  a  man 
weighing  70  kilos  would  require  to  take  food  equivalent  to  about 
2800  calories  for  light  work,  and  about  3500  to  4000  calories  for 
heavy  work.  But  Fletcher  got  along  well  on  1600  calories  with 
a  body  weight  of  186  pounds.  However,  he  lost  some  weight,  36 
pounds,  but  became  healthier  and  stronger  than  he  was  previously. 
Later  on  he  still  further  reduced  his  diet  and  lived  on  38  grammes 
of  albumin  and  1581  calories,  continuing  in  perfect  health. 

By  a  series  of  experiments  on  a  number  of  healthy  Ameri- 
can soldiers,  continued  for  a  long  time,  Chittenden3  and  Horace 
Fletcher4  found  that  these  men  could  do  very  hard  work  with 

2  v.  Noorden:      "Die  Zuckerkrankheit,"  fourth  edition;     and  "Pathologie 
des  Stoffwechsels,"  fourth  edition,  vol.  i, 

3  Chittenden:     "Physiological   Economy   of  Nutrition,"  New  York,    1904, 
and  "The  Nutrition  of  Man,"  London,  1907. 

4H.  Fletcher;     "The  A,  B-Z  of  Nutrition,"  New  York,  1904. 


Food  Hygiene.  283 


an  average  of  only  55  grammes,  albumin  and  2700  calories;  and, 
what  is  more  interesting,  their  muscular  power  was  doubled. 

The  same  result  was  obtained  by  Professor  Chittenden  by 
experiments  on  seven  of  the  finest  athletes  among  the  2300 
students  of  Yale  University.  He  found  the  strength  of  these 
students  increased  as  much  as  48  per  cent.  One  of  them  won  the 
championship  in  gymnastics,  open  to  all  American  universities, 
during  the  course  of  these  experiments.  Rechenberg  found  that 
the  weavers  of  Zittau  in  Germany  required  65  grammes  of  pro- 
teids  a  day. 

Very  interesting  are  the  observations  of  Professor  Baelz,  of 
Tokio,  made  on  the  Japanese  coolies,  who  drew  the  jinrickshaw 
containing  Professor  Baelz,  who  then  weighed  160  pounds. 
These  coolies  took  carbohydrates,  mainly  rice,  with  a  proteid 
content  of  only  60  to  80  grammes.  They  were  able  to  do  their 
work  exceedingly  well  on  this  meager  diet.  One  day  Professor 
Baelz  gave  them  a  little  meat  which  they  took  for  three  days,  and 
then  refused  it,  saying  they  would  take  it  after  their  journey  was 
done.  Baelz  made  the  interesting  observation  that  these  men 
were  able  to  go  about  60  miles,  drawing  a  man  of  108  pounds, 
whereas  Baelz,  who  followed  riding  in  a  carriage,  had  to  change 
his  horse  six  times  and  only  beat  them  by  half  an  hour. 

The  author  of  this  book  has  observed  that  while  taking  il/2 
liters  of  milk  a  day,  2  eggs,  40  grammes  of  butter,  3  rolls,  3 
oranges,  a  pound  of  cherries,  a  cup  of  coffee  with  milk,  and 
one  tart,  he  was  able  to  live  very  well  for  about  two  months 
without  any  loss  in  weight.  The  milk  was  of  excellent  quality, 
containing  about  700  calories  to  the  liter,  and  about  34  grammes 
albumin ;  thus  he  was  taking  about  70  grammes  albumin  and  about 
2300  calories  a  day,  with  a  body  weight  of  155  pounds,  and  leading 
a  very  active  life  and  he  felt  better  than  ever  before. 

Still  we  would  not  like  to  generalize  and  say  that  55  or  60 
grammes  albumin  in  the  day  would  be  a  suitable  amount  for  every 
individual.  Here,  as  everywhere,  individuality  and  many  other 
circumstances  must  be  considered.     What  is  good  for  one  may 


284  Old  Age  Deferred. 


not  answer  in  the  same  way  for  another.  The  Japanese  have 
constitutions  different  to  the  Europeans,  for  which  reason  we 
cannot  apply  to  Europeans  facts  which  hold  good  for  Asiatics. 
Moreover,  not  everyone's  digestive  organs  are  capable  of  util- 
izing ingested  food  to  the  same  degree.  The  quality  of  the 
food  is  also  of  great  importance,  and  likewise  its  digestibility. 
Therefore  the  question  is  very  complex,  and,  for  these  and  other 
reasons,  the  discussion  of  which  would  lead  us  too  far,  we  cannot 
recommend  a  diet  containing  such  a  small  amount  of  albumin  for 
general   use. 

Everybody  likes  to  judge  from  his  own  experience,  and  so 
the  author  is  inclined  to  the  belief  that,  when  milk  is  taken  in 
large  quantities,  in  addition  to  fats  and  carbohydrates,  it  is  pos- 
sible to  get  along  with  a  smaller  amount  of  albumin,  and  of  calo- 
ries in  general.  Milk,  in  healthy  stomachs  and  intestines,  is  very 
easily  absorbed,  and  the  food  leaves  less  residue  than  most 
other  kinds  of  food.  Then,  again,  milk  contains  in  a  wonderful 
combination  all  the  three  main  groups  of  food.  So  we  believe 
that  when  milk  is  taken  as  the  main  article  of  diet  we  can  get 
along  with  a  smaller  number  of  calories,  without  any  prejudice 
to  our  health. 

According  to  Rubner5  the  following  number  of  calories  are 
indicated  daily: —  Carbo- 

Albumin  Fat  hydrates     Calories 
For  an  adult  of  50  kilos ),  .       ....  ,90  37  262  2102 

For  an  adult  of  70  kilos  ld0ingllghtWOrk     123  46  317  2631 

96 
For  an  adult  of  50  kilos  )  ,  .       ,  ,     , ,  0 

,   ,,     „ ,  .,      }  doing  heavy  work    118 

For  an  adult  of  70  kilos  S  s  J  g. 

Albuminous  food  serves,  according  to  the  prevalent  opinion, 
to  build  up  our  body  tissues,  carbohydrates  to  produce  the  energy 
that  is  necessary  for  muscular  work,  and  the  fats  to  produce  heat. 

Accordingly,  persons  who  are  growing  will  need  more  albu- 
min in  order  to  produce  body  tissues ;  and  albuminous  food  will 

5  Rubner :     "Physiologie  der  Nahrung  und  der  Ernahrungtherapie,"  Leip- 
zig, 1897. 


44 

404 

2472 

56 

500 

3094 

45 

322 

2111 

Food  Hygiene.  285 

be  indicated  for  those  who  have  had  much  loss  of  tissue,  as  in 
convalescence  after  wasting  disease.  By  albuminous  food  the 
waste  of  body  tissues  can  best  be  replaced.  Also  after  different 
kinds  of  excesses  where  tissue  is  wasted  {e.g.,  after  sexual  ex- 
cesses) albuminous  food  will  be  indicated. 

Such  a  food  is  also  necessary  for  women  during  pregnan- 
cies, and  especially  during  lactation. 

In  any  of  these  conditions  the  minimum  of  albuminous  food, 
taken  daily,  should  certainly  be  ioo  grammes.  But  other  persons 
can  often  manage  with  less  without  any  wasting  of  the  body  pro- 
teids,  so  long  as  carbohydrates  and  fats  are  taken  simultaneously 
in  sufficient  quantities. 

Besides  the  three  principal  groups  of  food  there  are  certain 
other  kinds  which  are  almost  as  indispensable,  e.g.,  mineral  matter 
and  water,  without  which  no  animal  or  man  could  live,  and  vege- 
table acids  and  cellulose. 

The  most  important  mineral  matters  are  lime  salts,  mainly 
in  the  form  of  phosphates.  They  are  present  in  greatest  amounts 
in  cows'  milk.  Common  salt  is  a  most  important  element  of  food, 
for  which  animals  and  men  often  risk  their  life.  As  Bunge 
shows,  where  vegetables  that  contain  much  potassium  are  taken, 
then  common  salt  must  be  taken  as  well.  He  has  shown  by 
experiment  upon  himself,  that  when  potassium  salts  are  taken  a 
great  quantity  of  sodium  chloride  is  eliminated  from  the  body. 
The  reason  is,  that  when  a  potassium  salt  is  taken,  e.g.,  carbo- 
nate of  potassium,  and  this,  in  the  blood,  meets  with  chloride  of 
sodium,  then  chloride  of  potassium  and  carbonate  of  sodium  are 
formed.  But  the  kidney's  duty  is  to  see  that  the  composition  of 
the  blood  is  maintained,  and  that  foreign  substances,  or  the  sur- 
plus of  a  normal  substance  like  carbonate  of  sodium,  are  elimi- 
nated. Hence  the  carbonate  of  sodium  and  the  chloride  of  potas- 
sium are  together  eliminated,  and  thus  our  blood  loses  two  im- 
portant elements :  chlorine  and  sodium.  Thus,  when  potassium 
is  taken,  the  body  loses  sodium  chloride,  and  then  more  of  this 
substance  is  required. 


286  Old  Age  Deferred. 


A  diet  of  potatoes  necessitates  much  salt,  as  they  are  rich 
in  potassium;  on  the  other  hand,  rice  contains  only  minimal 
quantities  of  potash.  Potatoes  contain  42  grammes  of  potassium 
in  100  grammes;  rice  only  1  gramme.  Thus  rice  as  food  would 
require  only  the  smallest  amount  of  salt. 

At  the  same  time  Bunge  points  out  the  great  dangers  to  the 
kidneys  of  a  diet  from  which  quantities  of  an  alkali  salt  are 
formed  and  circulate  through  these  organs.  We  can  draw  a 
practical  conclusion  of  great  value  from  Bunge's  observations, 
and  not  use  much  salt  in  our  food,  nor  too  large  quantities  of 
vegetables  containing  much  potassium,  if  we  want  to  save  our 
kidneys  from  harm.  That  salt  is  deleterious  to  the  kidneys, 
especially  when  previously  damaged,  is  shown  by  the  works  of 
Achard  and  Loeper,6  Strauss,7  Vidal  and  Javal,8  and  others.  We 
have  enlarged  upon  this  in  our  chapters  on  the  functions  of  the 
kidneys  and  their  hygiene. 

A  mineral  of  great  importance  is  iron,  which  is  contained 
in  pig's  blood  to  the  largest  extent,  and  in  certain  vegetables 
and  fruit  in  considerable  quantities.  Vegetables  and  fruit  are 
also  rich  in  vegetable  acids,  and  also  contain  a  large  amount  of 
cellulose,  which  plays  an  important  role  in  the  normal  evacuation 
of  the  bowels,  being  the  most  natural  stimulus  for  this  purpose. 

Condiments  are  also  indispensable  in  a  certain  quantity  with 
our  food,  for  without  them  the  food  would  have  no  taste  and 
would  not  stimulate  appetite,  which  is  of  great  importance  for 
digestion.  On  the  other  hand,  too  much  of  these  condiments 
would  irritate  vital  organs,  like  the  stomach,  intestines,  liver, 
kidneys,  etc.  Therefore  they  should  only  be  used  in  modera- 
tion, and  the  more  potent  ones,  like  mustard  and  pepper,  should 
be  avoided,  or  only  taken  in  minimal  quantities.  Vinegar  would 
not  be  so  bad  if  it  did  not  so  often  contain  sulphuric  acid.  Cer- 
tain sharp  sauces  which  are  much  used  are  veritable  poisons  to 

6  Achard  and  Loeper:      C.  R.  Soc.  biologie,  23  Mars,  1901. 
1  Strauss:     Die  chronischen  Nierenentzundungen,  Berlin,  1902. 
8 Vidal   et  Javal:      Soc.   MM.   des  Hopitaux,   26  J.,    1903;     Vidal:      "Le 
regime  dechloruse,"  Li§ge  Congr£s  de  Med.,  1905. 


Food  Hygiene.  287 


the  kidneys.  This  is  true  of  soup  that  contains  them,  and  even 
strong  bouillon,  when  it  is  taken  every  day  in  large  quantities, 
may  be  injurious  to  the  kidneys  and  affect  unfavorably  the  blood 
pressure  since  it  contains  many  meat  extracts.  To  minimize  the 
dangers  of  all  these  kinds  of  harmful  materials,  and  also  of  the 
end-products  of  nitrogenous  food  when  passing  through  the 
kidneys,  it  is  best  and  healthiest  to  drink  large  quantities  of 
water,  hard  water  being  most  desirable,  according  to  Roese, 
because  of  its  richness  in  lime  salts.  It  is  advisable  to  drink  this 
after  meals;  but  if  water  is  not  taken  in  too  large  quantities  it 
may  be  perfectly  harmless  to  take  it  during  meals.  It  helps  the 
appetite  in  many  persons,  and  encourages  the  absorption  of  the 
food.  If  taken  in  too  large  quantities  it  may  dilute  the  gastric 
juice,  although  in  such  a  case  the  glands  of  the  stomach  strive  to 
keep  up  the  standard  acidity,  and  secrete  more  acid  in  conse- 
quence. As  shown  previously,  a  certain  degree  of  fluidity  of  the 
intestinal  contents  is  indispensable  for  the  healthy  action  of  the 
bowels.  For  all  these  reasons  we  recommend  a  moderate  amount 
of  good  fresh  water  daily.  Happily,  most  of  our  foodstuffs, 
especially  green  vegetables  and  fruit,  contain  water  in  large 
quantities. 

Under  the  name  stimulants  we  include  various  kinds  of  food 
accessories.  The  most  important  of  these  are  alcoholic  drinks. 
It  has  been  shown  by  physiologic  experiments  that  when  alco- 
hol is  taken  in  moderate  quantities  it  is  harmless,  and  at  the  same 
time  may  be  of  value  as  a  nutrient  foodstuff.  It  is  evident  from 
the  result  of  the  experiments  of  Atwater  and  Benedict  that  alcohol 
has  a  nutritive  value,  and  that  as  a  kind  of  fuel  it  can  largely 
replace  carbohydrates  and  fats.  In  such  quantities  it  also  stimu- 
lates digestion  and  other  functions,  e.g.,  those  of  the  heart  and 
nervous  system.  Such  small  quantities  of  alcohol  are  contained 
in  beer  and  wine.  According  to  Rubner,  ioo  parts  of  beer 
contain : — 

Alcohol 

Bavarian   beer    3.45 

Pilsner    3.46 


Albumin 

Extracts 

0.61 

5.3 

0.4 

5.0 

288  Old  Age  Deferred. 


English  and  American  beers,  however,  are  much  stronger 
in  alcohol;  thus  Scotch  ale  contains  8.50  per  cent,  of  alcohol; 
London  porter,  6.90  per  cent. ;    lager  beer,  3.90  per  cent. 

Beer  is  also  of  nutritive  value  on  account  of  its  sugar  and 
dextrine,  which  are  in  considerable  amount,  especially  in  dark 
beers;  it  also  contains  an  appreciable  amount  of  albumin. 
On  the  other  hand,  beer  has  the  disadvantage  of  forming  uric 
acid  in  considerable  quantities,  as  shown  by  Walker  Hall  and 
Haig.  Beer  also  conduces  to  obesity.  There  can,  however,  be 
no  harm  in  taking  a  small  amount  of  light  beer  every  day. 

Wine  contains  proteid  substances,  carbohydrates,  and  salts. 
In  some  kinds  of  wine,  like  port,  sherry,  Tokayer,  Malaga,  and  Ma- 
deira, there  are  large  quantities  of  sugar.  The  alcohol  contents 
of  the  different  kinds  of  wine  are  given  by  Rubner  as  fol- 
lows : — 

Tyrolean   wines    8.3  per  cent. 

French  red  wine 9.4     "       " 

Rhine   wines    11.1     "        " 

Palatial   (Rfalz)   wines 11.5     " 

Mosel     12.1     " 

Thus,  Tyrolean  wines  are  the  lightest,  French  wines  come 
next,  but  Mosel  wines  are  the  strongest,  in  spite  of  the  popular 
belief  that  they  contain  only  little  alcohol. 

Wines  contain  more  acids  than  beer  (0.41  per  cent,  to  0.69 
per  cent.,  according  to  Rubner),  whereas  beer  has  only  0.1  per 
cent.  As  wine  contains  vegetable  acids,  just  as  do  vegetables 
and  fruit,  they  may  be  of  a  certain  dietetic  value  on  this  account. 

We  do  not  think  it  harmful  if  old  people  drink,  every  day, 
a  few  glasses  of  good  French  claret,  although  we  are  not  pre- 
pared to  indorse  the  dictum  of  Hufeland  that  wine  is  the  milk 
of  the  old.  Much  greater  precaution  must  be  taken  in  the  en- 
joyment of  spirits:  brandy  (cognac),  whiskey,  and  rum.  These 
beverages  contains  50  to  60  per  cent,  of  alcohol.  Still  we  do  not 
think  that  small  amounts  of  whiskey,  if  taken  occasionally  and 
in  measured  quantities,  can  be  dangerous.  Care  must  be  taken 
to  get  whiskey  of  good  quality.     There  can  be  no  doubt,  how- 


Food  Hygiene.  289 

ever,  that  when  large  quantities  are  taken,  as  in  dipsomania,  old 
age  is  brought  on  sooner.  It  is  claimed  that  after  taking  whiskey- 
less  uric  acid  is  eliminated  than  after  taking  the  other  alcoholic 
beverages,  as  beer  or  some  kinds  of  wine. 

Coffee,  tea,  and  cocoa  also  belong  to  the  class  of  stimulants, 
and  we  will  treat  of  them  in  a  special  chapter,  as  also  of  tobacco. 

Great  moderation  must  be  observed  in  the  amount  of  food 
we  take  daily.  Too  rich  food  would  induce  not  only  diseases 
of  the  digestive  organs,  but  also  disorders  of  metabolism,  like 
obesity,  gout,  or  diabetes,  and  thus  shorten  life.  Arteriosclerosis 
is  also  promoted  by  such  a  diet. 

The  more  food  also  the  more  exercise  should  be  taken,  and 
the  more  we  work  the  more  food  should  we  take. 

Aged  persons  should  take  less  proteid  food  and  more  carbo- 
hydrates. Proteid  food  is  better  suited  to  young  persons  who 
are  growing.  Besides  carbohydrates,  milk  is  also  especially  in- 
dicated for  old  persons,  as  are  also  certain  amounts  of  fat, 
butter,  etc. 

The  amount  of  food  should  also  depend  upon  the  climate; 
thus,  in  winter  more  fat  should  be  taken,  for  fat  produces  heat. 
Inhabitants  of  northern  climes  eat  much  fat,  and  in  Scandi- 
navia more  butter  is  taken  than  in  southern  countries.  In  hot 
summer  weather  little  proteid  food  is  required,  and  carbohy- 
drates, vegetables,  and  fruit  are  more  suitable. 

Much  depends  on  the  preparation  of  food.  In  the  process 
of  cooking  the  food  should  be  brought  into  the  most  advan- 
tageous form  for  absorption  and  assimilation.  Therefore  much 
depends  upon  the  way  in  which  the  food  is  cooked,  and  the 
great  importance  of  this  fact  is  shown  by  the  establishing  of 
courses  in  cooking  in  Berlin  under  the  direction  of  Prof.  H. 
Strauss. 

In  the  choice  of  food  attention  must  be  paid  to  its  digesti- 
bility. A  robust  man,  who  works  hard  and  takes  much  exercise, 
can  digest  easily  the  most  indigestible  vegetable  food,  whereas 
a  man  occupied  with  scientific  work  and  sitting  down  all  day 

19 


290  Old  Age  Deferred. 


will  have  a  greater  difficulty  in  digesting  it.  Aged  persons, 
whose  digestive  glands  are  atrophied,  are  unable  to  digest  food 
which  presents  great  difficulties  to  the  action  of  their  juices. 
Therefore  raw  milk,  whipped  eggs,  tripe,  lamb,  rice,  sago, 
tapioca,  barley,  and  soft  boiled  eggs,  are  the  most  digestible  foods 
for  them.  Of  the  vegetables,  rice  is  among  the  easiest  to  digest, 
and  it  will  also  soonest  disappear  from  the  stomach.  There  are 
special  preparations  made  from  various  kinds  of  cereals,  finely 
ground,  and  containing  the  most  nourishing  elements,  and  these 
may  be  advisable  for  aged  persons.  There  are  also  albuminous 
foodstuffs  in  which  the  albumin  is  changed  into  the  form  of 
peptones.  However,  it  has  been  shown  by  Professor  Ewald  that 
they  contain  very  little  peptone,  but  mainly  albumose,  its  pre- 
cursor. Others  of  these  foodstuffs  have  the  starch  trans- 
formed into  dextrin  or  maltose.  There  can  be  no  doubt  that 
aged  persons  will  thrive  and  prosper  on  the  best  of  these  prepa- 
rations, which  also  have  the  advantage  that  they  can  be  taken 
in  conjunction  with  milk.  Another  point  in  their  favor  is  that 
they  require  little  mastication. 

We  add  here  a  table  after  Professor  Ewald,  of  Berlin,  on 
the  digestibility  of  the  various  kinds  of  food : — 

Table  Indicating  the  Digestibility  of  Different  Kinds  of  Food. 

The  following  food  leaves  the  stomach  in  1  to  2  hours: — 
100  to  200  gr.  of  pure  water.  200  gr.  light  wine. 

220  gr.  aerated  water.  100  to  200  gr.  milk. 

200  gr.  tea.  200  gr.  bouillon. 

200  gr.  coffee.  100  gr.  eggs   (soft  boiled). 

200  gr.  beer. 

A  longer  time,  2  to  3  hours,  is  required  for  the  digestion  of  the  following 
food: — 

200  gr.  coffee  with  cream.  200  gr.  dried  cod,  boiled. 

200  gr.  cocoa  with  milk.  150  gr.  asparagus,  boiled. 

300  to  500  gr.  water.  150  gr.  potatoes,  boiled. 

300  to  500  gr.  beer.  150  gr.  potatoes,  mashed. 

300  to  500  gr.  milk.  150  gr.  cherries,  a  compote. 

100  gr.  raw  eggs,  hard  boiled  eggs,  or  150  gr.  cherries,  raw. 

omelette.  70  gr.    white    bread,    new    or    stale, 
250  gr.  sweetbread  boiled.  dry  or  with  tea. 


Food  Hygiene. 


291 


72  gr.  fresh  oysters  boiled. 
200  gr.  carp  boiled. 
200  gr.  pike,  boiled. 
200  gr.  haddock. 


70  gr.  biscuit,  fresh  or  .-tale,  dry  or 

with  tea. 
50  gr.  Albert  biscuits. 


A  still  longer  time,  3  to  4  hours,  is  required  by:  — 


230  gr.  young  chickens,  boiled 
230  gr.  partridges. 
220  to  260  gr.  pigeons. 
195  gr.  pigeon,  roast  or  broiled 
250  gr.  beef,  boiled. 
100  gr.  ham,  raw  or  boiled. 
100  gr.  roast  veal,  hot  or  cold. 
100  gr.  beefsteak,  roasted. 
100  gr.  sirloin  of  beef. 
200  gr.  salmon,  boiled. 
I'l  gr.  caviar,  salted. 


150  gr.  dark  bread. 
150  gr.  brown  bread. 
150  gr.  white  bread. 
100  to  150  gr.  Albert  biscuits. 
150  gr.  potatoes. 
150  gr.  kohlrabs,  boiled. 
150  gr.  carrots. 
150  gr.  spinach.' 
150  gr.  cucumber  salads. 
50  gr.  apples. 


The  following  food  demands  the  longest  time  for  its  digestion: — 

210  gr.  pigeons,  roasted.  250  gr.  goose,  roasted. 

250  gr.  filet  of  beef,  roasted.  250  gr.  duck,  roasted. 

250  gr.  beef  steak,  roasted.  200  gr.  herring,  salad. 

250  gr.  tongue,  smoked.  150  gr.  lentils,  mashed. 

200  gr.  hare,  roasted.  200  gr.  peas,  mashed. 

240  gr.  partridges,  roasted.  150  gr.  green  beans,  boiled. 

The  digestibility  of  these  various  kinds  of  food  is  calcu- 
lated for  the  normal  stomach.  By  following  the  above  table  we 
can  make  the  best  choice  of  easily  digestible  food.  Especially 
for  aged  persons  we  should  choose  such,  and  at  the  same  time  we 
should  mince  them,  or  give  them  in  the  form  of  porridge,  which  is 
still  better.  We  must  do  this  because  aged  persons  do  not  pos- 
sess, as  a  rule,  good  teeth,  if  any,  and  thus  cannot  fulfill  the 
demands  of  mastication,  which  we  will  treat  of  later  on  in  a  sepa- 
rate chapter. 

The  food  should  not  be  too  hot  nor  too  cold,  as,  if  it  is,  the 
stomach,  and  even  intestines  may  be  damaged;  on  the  other 
hand,  as  a  rule,  warm  food  disappears  sooner  from  the  stomach ; 
but  there  are  many  exceptions  to  this  rule. 

The  keynote  in  the  hygiene  of  food  is  moderation.  We 
should  never  eat  more  than  necessary  to  satisfy  hunger.  Most 
people    know    when    they   have    had    enough ;    and    as    a    rule 


292  Old  Age  Deferred. 


animals  never  eat  more  than  enough  to  satisfy  them,  and  then 
they  will  refuse  more  food.  But  with  the  intelligent  human 
being  it  is  different,  and  there  are  not  a  few  who  eat  more  than 
they  require,  and  thus  dig  their  graves  with  their  teeth.  Mod- 
eration is  all  important;  it  is,  indeed,  the  cause  of  longevity  of 
those  persons  who  live  about  ioo  years. 

We  know  the  story  of  Cornaro,  who  became  ill  at  40 
through  immoderate  living.  He  recovered  his  health  by  reduc- 
ing his  food  to  the  necessary  amount  only,  and  then  lived,  happy 
and  healthy,  to  100  years.  Mr.  Horace  Fletcher,9  and  many 
other  persons,  have  recovered  their  health  through  moderation 
in  food,  after  having  come  to  the  brink  of  death  through  im- 
moderation. Such  examples  we  may  often  see,  and  they  are 
eloquent  advocates  of  moderation  in  diet. 

We  will  show  later  that  we  can  only  digest  food  that  we 
eat  with  relish;  therefore  never  let  us  be  persuaded  to  par- 
take of  food,  or  compel  ourselves  to  eat,  when  we  are  not  hun- 
gry. Therefore,  at  least  six  hours  should  pass  between  dinner 
and  supper,  and  five  hours  between  breakfast  and  dinner.  It  is 
more  healthy,  and  especially  conducive  to  healthy  sleep,  to  have 
dinner  at  12  or  1,  and  supper  at  6  or  7.  Meat  should  only  be 
taken  once  a  day,  at  dinner,  and  in  the  evening  much  less  should 
be  eaten  than  at  noon.  Meat  should  never  be  taken  for  break- 
fast.   We  would  recommend  the  following  diet : — 

BREAKFAST. 

Grape  fruit  or  oranges,  2  eggs  (soft  boiled),  cereals,  stewed 
fruit,  white  or  brown  bread,  fresh  butter,  a  teaspoonful  of 
marmalade  or  other  kind  of  jam,  fresh  cherries,  or  fresh  straw- 
berries, or  other  fruit  in  season,  especially  grapes,  half  to  one  pint 
of  milk. 

DINNER. 

Soup,  fish  or  meat,  vegetables,  stewed  fruit,  fresh  fruit, 
white  or  brown  bread. 

9  Loc.  cit. 


Food  Hygiene.  293 

SUPPER. 

Like  breakfast :  one  pint  of  milk,  or  half  a  pint  of  sour  milk, 
kefir,  or  koumiss.     Also,  if  liked,  sour  milk  during  the  day. 

In  the  above  diet  list  we  have  a  variety  of  foods,  which 
variety  is  of  great  importance. 

It  is  very  advantageous,  according  to  our  observation,  to 
append  to  this  diet  some  milk,  carbohydrates,  fat,  green  vege- 
tables, and  fruit,  with  the  exclusion  of  meat.  This  we  may  do, 
especially  if  the  weather  is  warm  in  spring,  summer,  or  early 
autumn;  but  in  winter  the  above  diet  with  meat  should  be 
taken.  It  would  be  an  excellent  thing  to  take  these  two  diets 
in  alternating  periods.  Much  will  depend  upon  the  tastes  of 
each  person,  and  the  special  indications  which  we  give  later  on 
in  their  respective  chapters. 

When  no  meat  is  eaten,  then  at  least  ij4  to  2  liters  of  rich 
milk  should  be  taken,  and  some  cream  cheese. 

After  these  general  remarks  on  food  we  will  treat  of  the 
merits  and  drawbacks  of  the  various  kinds  of  food. 


CHAPTER  XXXV. 


On  Proteid  Food,  Animal  Food,  Meat,  Fish, 
Eggs,  Milk,  etc. 

Meat  is  the  commonest  animal  food,  is  the  most  nutritious,  and 
most  closely  resembles  in  its  composition  our  own  bodily  tissues. 
Because  the  albumin  of  meat  is  much  better  absorbed  than  any 
other  kind  of  albumin,  such  food  can  replace  wasted  body  ele- 
ments in  a  shorter  time  than  can  any  other  kind  of  nutriment. 

Even-  the  albumin  of  milk  leaves  more  residue  than  that 
of  meat.  From  this  latter,  therefore,  is  derived  the  most  benefit 
during  the  period  of  bodily  growth,  or  in  the  other  conditions 
above  mentioned ;  but  it  will  not  be  so  efficacious  in  those  whose 
growth  is  already  finished,  or  whose  body  tissues  are  wasted  by 
disease  or  by  other  demands  on  them. 

Meat  contains  very  valuable  nutritive  elements,  such  as 
large  quantities  of  proteids  and  fat,  but  very  little  carbohydrates ; 
also  various  important  salts,  such  as  chlorides,  phosphates,  and 
carbonate  of  potassium.  Meat  also  contains  iron,  the  largest 
amount  being  found  in  the  blood  of  pigs.  We  can  estimate 
the  nutritive  value  of  different  kinds  of  meat  from  the  follow- 
ing table;  according  to  Professor  Rubner,1  each  100  parts 
contain : — ■ 


Food. 


Lean  beef  . 
Fat  beef  .  . 
Fat  pork  . .  . 
Lean  pork  . 
Lean  veal  . 
Fat  veal  .  . 
Fat  chicken 

Hare    

Herring 
Bacon     .... 


Albumin. 

Fat. 

Calories. 

20.6 

1.5 

98 

16.9 

27.2 

327 

14.5 

37.3 

406 

19.9 

6.8 

145 

19.8 

0.8 

89 

18.9 

7.4 

146 

18.5 

9.3 

162 

23.3 

1.1 

•106 

10.1 

7.1 

107 

95.3 

886 

1  Rubner  : 
zig,  1897. 

(294) 


"Physiologie  der  Nahrung  und  der  Ernahrungtherapie,"  Leip- 


Proteid  Food.  295 


In  addition  to  the  above  nutritive  elements  there  are  also 
a  series  of  extractive  substances  to  which  is  due  the  pleasant 
taste  of  the  meat.  When  such  food  is  boiled  these  substances  and 
salts  pass  into  the  water,  and  such  meat  loses  in  flavor,  though 
not  in  its  nutritive  qualities,  for  the  water  i.e.,  the  soup  is 
not  nutrimental  at  all.  Meat,  if  prepared  for  the  table  directly- 
after  the  animal  is  killed,  would  not  be  palatable ;  and  it  is,  there- 
fore, necessary  for  it  be  kept  for  a  given  time  before  it  is  eaten. 
Dr.  Wiley,  of  Washington,  considers  that  meat  improves  if  kept 
not  exceeding  fourteen  days  in  cold  storage,  after  which  time  it 
begins  to  lose  its  best  qualities. 

When  meat  is  chilled  it  does  not  lose  its  pleasant  taste ;  but 
when  it  is  frozen  the  case  is  very  different,  for  then  it  loses  its 
beneficial  juices,  which  escape  into  the  surrounding  ice.  In  such 
meats,  therefore,  the  extractives  which  give  the  pleasant  flavor 
are  wanting.  Refrigerated  meat  generally  arrives  in  Europe  in 
excellent  condition  from  America. 

Before  animals  are  slaughtered  to  be  used  for  food  a  rig- 
orous examination  by  veterinarians  must  be  made,  in  order  to 
avoid  poisoning  from  meat  in  a  condition  of  putrefaction,  or 
from  diseased  animals.  Some  animals,  such  as  pigs,  very  often 
suffer  from  acute  inflammatory  diseases  caused  by  catching  cold 
while  on  long  journeys  prior  to  being  slaughtered.  Fortunately, 
in  the  early  stages  of  such  illness  there  is  little  danger,  for  it  can 
be  avoided  by  thorough  bleeding.  The  Jewish  method  of  bleed- 
an  animal  is  thus  particularly  to  be  recommended,  for  by  this 
means  poisonous  products  can  leave  the  animals'  bodies  in  large 
quantities.  Meat  retaining  all  the  natural  blood  decomposes  very 
rapidly,  especially  in  hot  climates,  and  we  must  not  forget  that 
such  poisonous  substances,  as  ptomaines,  in  meat,  are  not  de- 
stroyed by  the  process  of  cooking. 

The  greatest  danger  from  poisoning  lies  in  oysters,  which 
are  otherwise  a  most  digestible  food.  This  is  owing  to  the  fre- 
quent presence  of  sewage  contamination  in  the  waters  where  they 
are  bred,  thereby  causing  veritable  epidemics  of  typhoid  fever. 


296  Old  Age  Deferred. 


Just  as  in  fish  foods,  oysters  and  mussels,  sausages  in  the  meat 
foods  are  the  most  frequent  cause  of  poisoning  when  they  are  not 
quite  fresh  and  thoroughly  sound,  and  from  such  a  cause  epi- 
demics from  poisoning  are  frequent  in  Germany.  Sausages  are 
a  very  nutritious  food,  as  they  contain  a  large  amount  of  fat; 
their  greater  value  when  made  from  the  blood  of  pigs,  on  account 
of  its  richness  in  iron,  will  be  specially  dealt  with  in  another 
chapter. 

Fish  contain  somewhat  less  albumin  and  much  more  water 
than  meat,  but  some  of  them  are  rich  in  fat,  such  as  the 
eel.  We  show  in  the  following  table  the  nutritive  values  in  each 
ioo  parts  of  some  of  the  most  frequently  eaten  fish : — 


Herring    ( Rubner ) 
Haddock    ( Rubner ) 
Salmon  (Pavy)    .  .  . 

Eel    (Rubner)    

White  fish   (Pavy) 


Albumin. 

Fat. 

Calories. 

10.1 

7.1 

107 

17.1 

0.3 

73 

16.10 

5  50 

110 

17.8 

28.4 

317 

18.10 

2.90 

102 

Fish  contain  as  a  rule  very  little  extractive  substances  com- 
pared with  meat,  and  are  therefore  less  tasteful ;  but  still  the  fatter 
fish  have  an  agreeable  flavor,  and  are  pleasant  to  the  taste.  As 
a  general  rule,  they  are  more  digestible  than  meat,  and  also 
have  less  of  other  disadvantages  than  meat  food,  on  which  we 
will  dwell  more  fully  in  another  chapter. 

On  the  other  hand,  it  is  more  important  than  with  meat  that 
fish  should  be  absolutely  fresh,  which  would  be  best  attained 
by  keeping  them  alive  in  water  until  just  before  being  required 
for  the  table.  Boiled  fish  is  the  most  digestible,  fried  less  so,  and 
pickled  or  smoked  the  least. 

The  most  perfect  animal  food  is  milk,  as  it  contains  all  the 
three  principal  elements  of  nourishment,  and  in  normal  digestive 
organs  is  easily  resorbed.  As  in  the  case  of  meat  diet,  we  will 
deal  more  fully  with  this  most  important  and  wholesome 
food  in  a  special  chapter.  We  will  content  ourselves  with 
mentioning  here  that  milk  not  only  contains  the  three  principal 
elements  of  food,  but  also  most  of  the  equally  important  organic 


Proteid  Food. 


297 


and  inorganic  minerals,  without  which  life  would  be  impossible. 
It  contains  very  important  organic  phosphorized  combinations 
in  the  shape  of  lecithin  and  nuclein ;  and  of  the  inorganic  salts, 
lime  exists  in  milk  in  a  much  greater  degree  than  in  any  other 
food.  Besides  the  albumin,  carbohydrates,  and  fat  which  it  con- 
tains, milk  comes  under  the  category  of  foods  which  are  richest 
in  mineral  salts,  especially  lime,  of  which  cows'  milk  contains 
15 10  milligrammes  in  every  100  grammes  of  desiccated  sub- 
stance, according  to  Bunge.  In  iron  only  is  cows'  milk  very  poor, 
and  therefore  when  milk  forms  the  main  part  of  our  daily 
nourishment  it  will  be  necessary  to  partake  of  iron  at  the  same 
time,  which  we  can  best  do  by  eating  sausage  and  puddings 
made  from  pigs'  blood  (see  Chapter  XXXVIII). 

According  to  Professor  Rubner  milk  and  the  various  prod- 
ucts of  milk  contain  the  three  main  elements  of  food,  in  each  100 
parts,  as  follows : — 


Carbo- 

Albumin. 
3.4 

Fat. 

hydrates. 
4.8    . 

Calories. 

Cows'   milk    

3.6 

67 

3.7 

25.7 

3.5 

268 

Buttermilk   

3.8 

1.2 

4.6 

41 

Whey 

0.8 

0.2 

3.4 

24 

Butter   

0.9 

30.4 

2.5 

404 

Cream  cheese   

27.2 

83.1 

0.5 

779 

According  to  Bunge  the  following  is  the  composition  of 
cows'  milk,  human  milk,  and  the  milk  of  some  animals  which 
rank  nearest  to  human  milk ;  each  100  parts  contain : — 


Woman 

Cow    . . 
Horse   . 

Ass   .  .  . 
Goat   .  . 


Casein. 


1.2 

3.0 
1.2 
0.7 
2.4 


Albumin. 

Fat. 

Sugar. 

0.5 

(si 

(HI 

0.5 

3.7 

4.9 

0.8 

1.2 

5.7 

1.6 

1.6 

6.0 

0.8 

4.3 

3.6 

The  milks  nearest  to  human  milk  in  composition  are  those  of 
the  horse,  ass,  and  goat.  It  is  a  very  interesting  fact  that  goats' 
milk  contains  ten  times  as  much  iron  and  nearly  seven  times  as 


298  Old  Age  Deferred. 


much  lime  as  human  milk,  and  also  ten  times  as  much  iron  and 
eight  times  as  much  lime  as  cows'  milk.  On  account  of  its  nearer 
similitude  to  human  milk  than  the  cows'  milk,  and  also  because 
of  its  being  richer  in  valuable  minerals,  we  will  later  on,  in  the 
chapter  on  the  advantages  of  milk  food,  advocate  its  use  in  prefer- 
ence to  cows'  milk.  We  will  also  show  at  the  same  time  that  milk 
must  not  be  boiled,  for  by  so  doing  very  valuable  ferments  con- 
tained in  the  milk  will  be  destroyed.  Woman's  milk  is  richer  in 
these  ferments.  According  to  Beauchamp,  Bouchut,  and  Moro, 
there  is  a  diastatic  ferment  in  breast  milk,  but  not  in  cows'  milk. 
Manfur  and  Gillet  found  a  saponifying  ferment  in  mothers'  milk 
which  is  less  active  in  that  of  cows.  Luzatti  and  Bianchini  found 
a  starch-separating  ferment  in  woman's  milk  which  is  absent  in 
cows'  and  goats'  milk.  According  to  Spolverini,  cows'  milk  has 
the  same  ferments  as  has  human  milk,  except  the  amylolytic  fer- 
ment, and  also  a  salol  splitting  element  that  has  been  discovered 
by  Nobecourt  and  Merklen  in  the  milk  of  woman. 

Butter  is  a  milk  product  in  daily  use,  and  is  one  of  the 
foods  most  used  in  our  diet ;  and  as  it  is  consumed  in  connection 
with  carbohydrates,  we  will  refer  to  it  later,  when  discussing  the 
question  of  carbohydrates  generally;  but  we  may  mention  here 
that  butter  must  be  taken  only  in  a  fresh  condition,  and  it  should 
not  contain  a  greater  proportion  of  salt  than  2.5  grains  per  ounce, 
for  reasons  we  have  so  often  insisted  upon  in  our  general  remarks 
on  food  when  referring  to  common  salt,  and  also  in  the  chapter 
on  the  hygiene  of  the  kidneys.  When  butter  is  in  a  rancid  condi- 
tion it  produces  acid  fermentation  in  the  stomach,  and  also  dis- 
orders of  the  intestinal  functions. 

Cheese  is  a  milk  product  very  rich  in  fat,  consisting  of  the 
coagulated  casein  of  the  milk  fats  and  salts.  American,  Cana- 
dian, and  English  cheese  are  manufactured  from  pure  milk,  while 
the  majority  of  cheeses  of  other  manufacture  are  made  from 
skimmed  milk.  A  very  nutritive  cheese  is  made  in  Norway 
from  the  pure  milk  of  goats ;  this  has  a  very  pleasant  taste  and 
is  very  easy  to  digest.     By  moderately  pressing  fresh  curds  cream 


Protcid  Food.  299 


cheese  is  made ;  and  we  are  of  the  opinion  that  in  this  form  it 
is  more  hygienic  than  old  cheese,  and  we  therefore  give  the 
preference  to  cream  cheese,  or  to  cheese  made  from  pure  milk  that 
is  not  old  or  sour.  Cheese  is  a  very  valuable  article  of  nourish- 
ment on  account  of  the  large  amount  of  albumin  and  fat  that  it 
contains.  Gervais  and  other  sorts  of  cream  cheese  have  a  very 
high  percentage  of  fat. 

Dr.  Haig2  recommends  cheese  as  a  valuable  article  of  food 
in  the  dietetic  treatment  of  uric  acid  diathesis.  It  has  also  the 
great  advantage  of  being  able  to  check  intestinal  putrefaction, 
owing  to  its  milk  and  fatty  acid  contents. 

On  the  other  hand,  sometimes  very  old  cheese  may  cause 
intestinal  putrefaction,  with  symptoms  of  intoxication,  and 
serious  catarrh  of  the  intestines.  Professor  Vaughan,  of  Ann 
Arbor,  found  toxic  ptomaine  bodies  in  cheese  and  old  and  stale 
milk. 

Many  people  are  unable  to  digest  cheese  well ;  others  develop 
skin  eruptions  or  acne  after  eating  it ;  but,  for  those  who  can 
take  it,  it  is  very  valuable  as  an  article  of  diet  when  a  lacto- 
vegetarian  regimen  is  followed,  as  suggested  in  our  general 
remarks  on  diet. 

In  addition  to  milk  and  meat,  the  next  most  important  ani- 
mal food  is  eggs,  which  are  very  rich  in  a  most  soluble  ani- 
mal albumin,  and  also  in  a  substance  which  plays  an  important 
part  in  the  structure  of  the  nervous  system — lecithin.  According 
to  Konig3  chicken's  eggs  have,  in  their  natural  watery  condition, 
13  per  cent,  of  albumin  and  0.3  per  cent,  of  fat;  and  89  per  cent, 
of  albumin  and  2  per  cent,  of  fat  in  the  dried  substance  of  the 
white  part ;  whereas  the  yolk,  in  the  natural  watery  state,  contains 
16  per  cent,  of  albumin  and  32  per  cent,  of  fat,  while,  if  dried,  33 
per  cent,  of  albumin  and  65  per  cent,  of  fat.  Eggs  also  contain 
much   lime. 


2 Haig:     Loo.  cit. 

3T.  Konig:     "Chemie  der  menschlichen  Nahrung  und  Genussmittel,"  sec- 
ond edition,  Berlin,  1882. 


300  Old  Age  Deferred. 


Eggs  with  milk,  carbohydrates,  and  fat  together  constitute 
a  food  which,  in  our  opinion,  is  the  most  perfect,  and  one  which 
will  enable  us  to  live  a  longer  life  in  perfect  health,  even  with 
a  complete  exclusion  of  meat;  though  if  we  take  in  addition  a 
little  of  this  latter  at  dinner  we  may  increase  considerably  in 
weight,  notwithstanding  bodily  exercise,  as  the  author  found  from 
personal  experience  and  from  observations  on  a  series  of  patients. 
Therefore,  we  again  repeat  that  the  above  appears  to  be  the  most 
beneficial  diet  to  follow  if  we  wish  to  obey  the  dictates  of  health 
and  enjoy  a  prosperous  long  life. 


CHAPTER  XXXVI. 

On  Carbohydrates  and  Fats,  and  the  Great  Advantages  of 
Vegetables  and  Fruit. 


Speaking  generally,  by  the  title  "carbohydrates"  is  prin- 
cipally meant  vegetable  food,  in  the  same  way  that  by  "albu- 
minous" animal  food  is  mainly  designated.  Still  there  are 
vegetables  which  contain  more  albumin  in  their  natural  watery 
condition  than  meat ;  thus  peas  contain  23  per  cent,  of  albumin, 
whereas  lean  beef  has  barely  21  per  cent.,  and  fat  beef  only  17 
per  cent.  But  one  thing  must  especially  be  considered,  and  that 
is  the  fact  that  a  considerable  portion  of  peas  (about  28  per 
cent.)  is  not  absorbed,  as  Rubner  has  shown,  whereas  nearly  the 
whole  albumin  contents  of  lean  beef  is. 

Most  albumin  is  found  in  leguminous  vegetables,  such  as 
peas,  beans,  and  lentils ;  and  these  are  also  rich  in  carbohydrates, 
as  will  be  seen  from  the  following  table  of  percentages  by  Rubner, 
in  which  reference  is  also  made  to  the  nutritive  value  of  our  most 
important  fresh  vegetable  foods  : — 


Food. 


Flour  of  peas 

Flour  of  beans   

Flour  of  lentils 

Flour  of  rice 

Flour  of  Indian  corn 

Flour  of  wheat 

Flour  of  rye   

Wheat  bread 

Rye  bread   

Potatoes  

Carrots    


25.7 

23.2 

25.7 

6.9 

14.0 

10.2 

10.9 

6.8 

6.0 

2.1 

1.0 


Fat. 


1.8 
2.1 
1.9 
0.5 

3.8 
0.9 
4.8 
0.8 
0.5 
0.1 
0.2 


Carbohy- 
drates. 


57.2 
58.9 
56.8 
77.6 
67.6 
74  7 
70.5 
57  4 
47.8 
21.0 
4.4 


Cellulofe. 


1.3 
1.8 
2.1 
0.1 
3.1 
0.3 
1.2 
0.4 
0.3 
0.7 
1.4 


Calor'es. 


362 
363 
364 
351 
382 
357 
383 
252 
226 
98 
50 


From  the  above  we  see  that  peas,  beans,  and  lentils  have 
the  most  nutritive  properties,  for  they  contain  not  only  much 
albumin  but  also  much  carbohydrates,  and  also  more  fat  (except 
in  the  case  of  ground  Indian  corn  and  rye),  than  the  other  above- 
mentioned  vegetables. 

(301) 


302  Old  Age  Deferred. 


Thus  we  shall  not  be  surprised  to  learn  that  we  can  thrive 
very  well  for  a  long  time  by  using  such  exclusively  for  food,  as 
has  been  proved  by  the  experiments  of  Rubner  and  Woroschi- 
loff.  The  drawback  to  this  kind  of  food  is  that  it  requires  the 
stomach  and  intestinal  juices  to  perform  much  more  work,  for 
reasons  already  mentioned;  and,  in  consequence,  less  of  it  is 
utilized;  and,  after  a  certain  time,  the  development  of  stomach 
and  intestinal  troubles  is  facilitated. 

Another  drawback  attending  vegetables  is  that  they  contain 
purin  bodies  and  form  uric  acid,  indeed  in  considerable  quan- 
tities, especially  peas  and  beans,  as  Walker  Hall  discovered  from 
experiments  conducted  in  the  Caroline  Institution  at  Stock- 
holm. Of  the  various  kinds  of  cereal  foods  rice  forms  the  least 
uric  acid,  and  also,  as  already  mentioned,  contains  the  least  salt, 
for  both  of  which  reasons  it  is  the  best  food  for  the  kidneys. 
It  is,  at  the  same  time,  a  very  valuable  nutritive  food,  as  it  con- 
tains a  very  large  quantity  of  carbohydrates,  viz. :  77.6  per 
cent.,  and  almost  the  least  cellulose  of  all  foodstuffs,  as  shown 
in  the  table  above ;  but  it  is  very  poor  in  fat,  and  has  also  but  a 
small  amount  of  albumin.  As  it  contains  so  little  proteid  and 
fat  its  adoption  by  people  with  vegetarian  proclivities  necessi- 
tates the  simultaneous  use  of  leguminous  vegetables  and  of  fats. 
It  has  the  advantage  over  leguminous  vegetables  in  that  its  starch 
components  are  extremely  digestible.  Thus  it  is  the  most  valu- 
able vegetable  food,  in  spite  of  its  being  poor  in  mineral  matters. 

Granted  the  enormous  value  of  rice  as  a  foodstuff,  we  must 
express  our  surprise  that  it  enters  in  so  small  a  degree  into  our 
daily  diet.  In  Europe,  and  in  other  parts  of  the  world  where 
persons  of  European  descent  reside,  as  also  in  America,  the 
potato  takes  the  same  place  as  rice  does  in  Asiatic  countries, 
though  the  former  is  much  less  rich  in  nutritive  Qualities,  as  we 
will  show  later  on. 

Rice  must  be  a  most  excellent   food,   for  the  natives  of 


1  Walker  Hall :     Berliner  klin.  Wochenschrift,  p.  868,  1903. 


Advantages  of  Vegetables  and  Fruit.  303 

Asiatic  countries,  who  live  almost  exclusively  on  this,  offer  us 
examples  of  great  tenacity,  and  of  resistance  against  bodily 
fatigue.  Take  the  Japanese  for  example.  Their  coolies,  as 
shown  already,  are  able  to  do  enormous  muscular  work  on  rice 
and  fish  food,  and  in  athletics,  such  as  jiujitsiu,  they  present  a 
great  example  of  muscular  strength,  though  it  cannot  be  denied 
that  it  is  more  their  dexterity  and  knack  than  their  superiority 
in  mere  strength  that  leads  them  to  victory.  That  by  means  of 
rice  diet,  as  by  carbohydrates,  great  muscular  energy  can  be 
obtained,  is  a  well-known  physiological  fact. 

The  starchy  portion  is  converted,  through  the  digestive 
ferments  in  the  saliva,  pancreatic,  and  intestinal  juices,  into  dex- 
trin and  grape  sugar;  absorbed  through  the  intestines,  it  is 
deposited  in  the  form  of  glycogen  in  the  liver,  the  muscles  also 
absorbing  a  large  part  of  this  glycogen.  Through  work  this 
glycogen  is  exhausted.  Thus  work  is  performed  mainly  at  the 
expense  of  the  carbohydrates,  which  are  the  prime  generators  of 
muscular  energy.  We  have  also  seen  that  the  above-mentioned 
Japanese  coolies  perform  their  incredible  muscular  efforts  largely 
on  such  food  only.  Still,  a  part  of  the  muscular  energy  of  the 
body  can  also  be  provided  by  the  proteids  and  fats. 

Carbohydrate  foods,  and  especially  those  that  are  poor  in 
fatty  contents,  such  as  rice,  and  especially  potatoes,  which  are  the 
most  deficient  of  all  (having  but  o.i  per  cent,  of  fat),  necessitate 
the  simultaneous  use  also  of  fat;  for  this  kind  of  exclusively 
carbohydrate  diet  would  invariably  lead  to  starvation  unless 
there  was  a  plentiful  supply  of  fat  with  it ;  and  the  best  and  most 
agreeable  form  to  introduce  fat  into  the  body  is  by  means  of 
butter. 

Butter  is  very  nutritious,  as  it  contains,  according  to  Rub- 
ner,  83.1  per  cent  of  fat,  0.9  per  cent,  of  albumin,  and  0.5  per 
cent,  of  carbohydrates.  One  hundred  grammes  of  butter  contain, 
according  to  Rubner,  779  calories.  In  addition  to  the  above, 
butter  also  contains  salts,  and  from  8  to  12  per  cent,  of  water. 
A  diet  rich  in  carbohydrates  could  not  be  well  assimilated  with- 


304  Old  Age  Deferred. 


out  butter ;  but,  at  the  same  time,  the  abundant  use  of  the  latter 
also  necessitates  the  use  of  carbohydrates,  which  are  the  best 
vehicle  for  butter ;  therefore,  when  in  diabetes  we  prescribe  much 
butter  or  other  fats,  we  make  it  a  rule,  also,  to  give  some  kind  of 
food  that  contains  some  amount  of  carbohydrates,  such  as  brown 
bread  or  green  vegetables,  or  sometimes,  in  mild  cases,  also 
boiled  potatoes. 

Potatoes,  when  new  and  watery,  contain  16  per  cent,  of 
carbohydrates ;  when  they  are  old,  22  per  cent.  In  many  Euro- 
pean countries  they  form  a  most  important  article  of  diet. 
Though,  as  shown  in  the  foregoing  table,  they  contain  only 
2  per  cent,  of  proteids,  they  contain  also  important  salts, 
such  as  a  certain  amount  of  citric  acid  and  citrates  of  potassium, 
sodium,  and  lime.  Thus  potatoes,  by  means  of  these  salts, 
are  also  an  alkaline  food,  and  if  consumed  in  very  large  quan- 
tities, the  acidity  of  the  urine  can  become  much  diminished. 
These  salts  are  burned  in  the  body,  and  the  potassium  is  then 
transformed  into  a  carbonate  salt.  Mosse  recommends  potatoes 
in  large  quantities  as  a  preventive  of  diabetes. 

Thus,  after  food  which  is  rich  in  such  vegetables  as  potatoes, 
or  after  fruit  with  much  fruit  acids,  the  urine  can  become  less 
acid;  but  after  food  that  abounds  in  proteids  the  urine  becomes 
acid.  This  happens  after  eating  much  meat,  or  leguminous 
vegetables  rich  in  proteids.  Such  a  very  acid  urine  is  often  passed 
by  diabetics;  therefore  in  their  diet  a  certain  amount  of  fruits, 
rich  in  salts  but  poor  in  sugar,  may  give  good  results. 

The  most  rational  diet  is  that  which  combines  all  the 
principal  items  of  nourishment — in  the  greatest  proportion  pro- 
teids, as  from  such  the  body  is  built  up  and  waste  tissues  re- 
placed ;  next  in  proportion  carbohydrates,  from  which,  as  already 
shown,  we  obtain  muscular  energy ;  and  to  a  smaller  extent  than 
the  two  preceding  must  be  taken  fat,  which  serves  to  produce 
heat  in  the  body.  Besides  these  three  important  constituents 
there  is  a  further  class  of  valuable  substances  indispensable  for 
our  well  being,  and  these  are  the  mineral  matters.     From  ex- 


Advantages  of  Vegetables  and  Fruit.  305 

periments  made  by  Lunin2  in  Bunge's  laboratory,  and  by  Forster/5 
it  has  been  shown  that  animals  cannot  live  if  fed  on  food 
that  is  devoid  of  mineral  matters;  and  the  latter  savant  has 
further  shown  that  animals  can  live  longer  without  any  food  at 
all  than  with  food  that  has  no  salt  whatever.  We  need  these 
salts  for  different  purposes,  such  as  building  up  the  skeleton ; 
and  the  condition  of  the  teeth  depends  also  on  the  richness  of 
our  bodies  in  lime,  and  in  order  to  obtain  this  it  is  indispensable 
to  introduce  food  that  contains  a  maximum  of  it.  This  is  of 
special  importance  in  the  nutrition  of  children. 

We  give  below  a  table  by  Bunge  showing  the  amount  of 
lime  contained  in  many  of  our  common  articles  of  diet;  ioo 
grammes  of  dried  substance  yields  milligrammes  of  lime: — 

Cows'  milk   1510  Dates    108 

Human  milk  243  White  of  egg   130 

Strawberries  483  Potatoes    100 

Figs    400  Pears    95 

Yolk  of  eggs  380  Malaga  grapes   60 

Prunes  160  Graham  bread   77 

Peas   137  But  beef,  only 24 

Probably  no  cell  growth  can  take  place  without  lime,  and 
even  if  grown  animals  are  fed  on  a  diet  containing  no  lime 
they  soon  become  weak  and  will  certainly  die  at  some  time  from 
it ;  therefore  not  only  children,  but  adults  also,  must  obtain  a  suf- 
ficient quantity  of  this,  and  milk  or  water  that  contains  lime  is 
certainly  the  best  means  by  which  to  get  it.  Very  interesting  are 
the  observations  of  Roese,3a  showing  that  in  parts  of  Germany 
where  water  poor  in  lime  is  drunk  less  people  are  fit  for  military 
service  and  the  teeth  of  the  population  generally  are  in  bad  condi- 
tion. Lime  is  indispensable  for  our  body,  for  it  has  a  favorable 
influence  upon  the  work  of  the  heart,  the  secretion  of  stomach 
juice,  and  the  movements  of  the  intestines;  it  increases  the  quan- 

2 Lunin:      Diss   Dorpat,    1880.      Zeitsehrift   fur   Physiolog.    Chemie,   vol. 
v.  March  1,  1881 ;    quoted  after  Bunge. 

3  Foster:     Zeitsehrift   fiir   Biologie,   vol.   ix,  p.   247,    1873;     quoted  after 
Bunge. 

3a  Roese,  "Erdsalzarmuth  und  Entartung,"  Berlin,  1908. 

20 


306  Old  Age  Deferred. 


tity  of  the  urine ;  and,  as  Lehmann,  Posner,  and  v.  Noorden  have 
shown,  the  carbonate  of  lime  dissolves  uric  acid. 

Another  most  important  mineral  salt  is  iron,  this  being  an 
essential  element  of  the  haemoglobin  of  the  blood.  This  latter  is 
the  red  coloring  matter  of  the  blood,  and  consists  of  the  combina- 
tion of  an  albuminous  body-globulin  with  a  ferruginous  body, 
the  hasmatin.  According  to  Bunge,4  a  man  weighing  70  kilos  has 
in  his  blood  3.2  grains  of  iron,  and  according  to  Schmidt  from 
2.4  to  2.7  grains. 

Bunge  maintains  that  organic  iron  is  more  readily  absorbed 
than  inorganic  iron,  and  that  the  best  way  to  obtain  sufficient  iron 
in  the   body   will   be   to   choose   a   food   that   is   rich    in    iron. 

We  present  below  a  table  by  Bunge,  showing  the  various 
articles  of  food  that  contain  the  greatest  percentage  of  iron;  100 
grammes  dried  substance  contain  milligrammes  of  iron : — 

Pig's  blood 226  Peas    6.2  to  6.6 

Spinach    33  to  39  Potatoes   6.4 

Asparagus   20  Huckleberries     5.7 

Yolk  of  eggs 10  to  24  Grapes    5.6 

Beef    17  Wheat 5.5 

Cabbage,  green  leaves 17  Rye    4.9 

Apples    13  Barley 4.5 

Red  cherries   10  Raspberries    3.9 

Almonds   9.5  Figs 3.7 

Lentils    9.5  Human  milk   2.3  to  3.1 

Strawberries    8.6  to  9.3  Cows'  milk  2.3 

Carrots   8.6  Dates 2.1 

White  beans    6.2  to  6.6  Pears 2.0 

Black  cherries   7.2  But  rice,  only 1.0  to  2.0 

We  thus  see  that  certain  kinds  of  fruits  and  vegetables  are 
noticeably  very  rich,  not  only  in  lime,  but  also  in  iron;  such  are 
strawberries,  Malaga  or  California  grapes,  peas,  potatoes,  etc. 

If  not  rich  in  lime,  yet,  on  the  other  hand,  rich  in  iron,  are 
certain  vegetables  and  fruits,  such  as  spinach,  asparagus,  the 
outer  leaves  of  cabbages,  lentils,  almonds,  apples,  cherries,  etc. 

As  it  is  very  probable  that  organic  iron  is  more  easily 
assimilated  than  inorganic,  it  would  be  advisable  in  those  cases 

4  Bunge :     hoc.  cit. 


Advantages  of  Vegetables  and  Fruit.  307 

which  require  a  better  nutrition  of  the  blood  and  an  increase 
of  its  contents  in  iron,  to  give  plentifully  the  above-named  vege- 
tables and  fruits. 

The  fruits  mentioned  as  being  rich  in  iron,  such  as  apples  and 
cherries,  or  in  iron  and  lime,  such  as  strawberries  and  grapes, 
can  not  only  increase  the  amount  of  iron  in  the  blood,  but  increase 
its  alkalinity ;  and  at  any  rate  if  they  cannot  increase  it  they  can 
at  least  preserve  it ;  and  not  in  the  blood  only,  but  also  in  the  other 
fluids  of  the  body,  this  being  effected  through  the  acids  contained 
in  such  vegetables,  such  as  citric,  tartaric,  malic,  acetic,  and  oxalic 
acids,  which  are  either  in  a  free  state  or  in  combination  with 
alkalies,  as  alkaline  salts.  After  the  combustion  of  the  acids  in 
the  body  they  appear  as  carbonates,  thus  increasing  the  alkalinity 
of  the  blood  and  other  fluids. 

Of  the  above  acids,  grape-fruit  contains  mostly  citric  acid, 
as  also  do  oranges,  lemons,  gooseberries,  etc. ;  apples  and  peas 
contain  malic  acid,  and  grape  juice,  tartaric  acid. 

There  can  be  no  doubt  that  the  above-named  fruits  and 
vegetables — and  let  us  not  omit  the  important  potato — are  able 
to  do  us  good  service  in  the  prevention  and  treatment  of  the 
condition  of  acid  intoxication  that  we  find  in  severe  forms  of 
diabetes  or  in  serious  disorders  of  the  liver;  but  also  in  uric 
acid  diathesis  they  can  render  valuable  assistance. 

For  a  long  time  past  through  various  kinds  of  fruit,  espe- 
cially berries,  various  cases  of  gout  have  been  successfully 
treated.  Strawberries,  cherries,  and  apples  especially  have  been 
recommended  in  such  conditions,  and  the  value  of  such  a  pre- 
scription has  been  confirmed  by  the  experiments  of  J.  Weiss,3 
made  in  Bunge's  laboratory.  We  also  used  grapes  in  large 
quantities,  besides  the  above-named  fruits. 

In  case  of  gravel,  also,  where  the  concrements  consist  of 
uric  acid,  the  administering  of  such  fruit  can  give  beneficial 
results. 


5  J.  Weiss:     Zeitschrift  fur  Physiolog.  Chemie,  vol.  xxv,  p.  303,  189S;    vol. 
xxvii,  p.  216. 


308  Old  Age  Deferred. 


Besides  mineral  salts  and  vegetable  acids,  fruits  and  vege- 
tables contain  a  third  important  substance,  which  is  cellulose, 
the  framework  of  their  cell  tissues.  Although  this  is  very  dif- 
ficult to  digest,  still  there  can  be  no  doubt,  from  the  experiments 
made  on  animals  and  also  on  man  by  Weiske,6  that  cellulose  is 
also  a  nourishing  food,  for  he  proved  on  himself  and  another 
person  that  from  46  per  cent,  to  65  per  cent,  of  the  cellulose  can 
be  digested. 

The  chief  advantage,  however,  of  cellulose  does  not  lie  in 
its  nourishing  properties,  which  are  not  great,  but  in  the  fact  that 
it  acts  as  the  best  natural  stimulus  to  the  peristaltic  movements 
of  the  intestines.  Thus  food  that  contains  such  a  residue  (which 
is  contained  most  largely  in  vegetables  and  fruit)  is  also  the  best 
to  use  if  we  desire  to  keep  the  intestines  open  and  to  observe  the 
most  important  precept  of  their  hygiene.  This  hygienic  condition 
can  also  be  much  advanced  by  vegetables  of  the  cereal  kind, 
which,  as  shown  in  the  chapter  on  hygiene  of  the  intestines, 
may  act  as  a  disinfectant  of  the  same  through  the  milk  acid  that 
is  formed  therefrom  in  the  intestines. 

Vegetables  and  fruit  have  thus  very  great  advantages,  and 
even  in  winter  our  daily  diet  should  consist  plentifully  of  them, 
as  grape-fruit,  oranges,  etc.,  can  be  obtained  at  that  time  of  the 
year.  But  when  vegetables  and  fruit  are  exclusively  used  as  a 
diet  they  present  certain  dangers,  as  we  point  out  in  the  next 
chapter  on  the  advantages  and  disadvantages  of  a  vegetarian  diet. 


6  Weiske:     Zeitschrift  fur  Biologie,  vol.  vi,  p.  456. 


CHAPTER   XXXVII. 

On  the  Advantages  and  Disadvantages  of  a 
Vegetarian  Diet. 

Owing  to  certain  peculiarities  in  our  anatomical  construc- 
tion we  are  not  intended  by  Nature  to  be  vegetarians.  This  is 
amply  demonstrated  when  we  consider  the  formation  of  our 
teeth.  These  are  neither  the  teeth  of  carnivorous  nor  of  herbiv- 
orous animals.  We  have,  in  fact,  teeth  similar  to  those  found 
among  omnivorous  animals,  such  as  the  dog  and  pig,  while  our 
whole  metabolism,  the  transformation  and  assimilation  of  food 
in  our  bodies,  presents  great  similarity  to  that  of  the  dog. 

The  construction  of  our  intestines  is  further  evidence  that 
Nature  did  not  intend  us  to  be  numbered  among  the  herbivorous 
animals,  which  are  required  to  have  an  enormously  long  intestine 
to  store  up  and  assimilate  the  very  large  quantity  of  herbs  or 
vegetables  which  are  necessary  to  satisfy  their  wants.  We  should 
have  to  possess  an  intestine  many  times  longer  than  we  are  pro- 
vided with  in  order  to  be  able  to  exist  on  vegetables  alone; 
and  even  with  such  an  intestine  it  would  be  very  difficult  for  us 
to  live  comfortably  for  a  long  period  on  a  purely  vege- 
tarian diet.  It  is,  however,  certainly  possible  to  exist  on  such 
a  diet  for  a  certain  time ;  and  it  may  be  of  direct  advantage  for 
those  persons  who  have  overtaxed  their  digestive  organs  by  large 
quantities  of  meat  food,  as  it  will  afford  the  said  organs  a  well 
merited  rest.  In  order  to  live  for  a  long  period  without  risk 
on  a  vegetarian  diet,  it  is  necessary  to  add  certain  products  of 
animal  sources,  such  as  milk  and  eggs.  We  know  from  personal 
experience  that  with  a  vegetarian  diet  supplemented  by  cereals, 
especially  rice,  milk,  butter,  and  eggs,  it  is  possible  to  exist  very 
comfortably  for  a  long  time,  and  to  thrive  on  it,  for  we  have 
frequently  witnessed  a  considerable  increase  in  the  weight  of  the 

(309) 


310  Old  Age  Deferred. 


body.  This  experience  we  have  also  gained  and  confirmed  by 
personal  test. 

A  vegetarian  diet,  when  supplemented  by  milk  and  butter, 
can  be  indulged  in  for  a  considerable  time,  and  advantage  may 
be  gained  therefrom.  In  many  cases  of  nervous  diseases  it  is 
of  excellent  value,  especially  in  neurasthenia  and  hysteria, 
Graves's  disease,  myxcedema,  etc.,  when  meat  food  is  deleterious, 
for  reasons  we  have  often  given.  With  such  a  diet  we  can  also 
avoid  all  the  dangers  which  threaten  us  from  the  formation  of 
uric  acid.  We  must,  however,  avoid  taking  in  large  quantities  of 
such  vegetables  as  beans,  peas,  etc.,  which,  according  to  Walker 
Hall,  contain  purin  bodies,  the  mother  substances  of  uric  acid. 

Rice  is  the  vegetable  which  will  form  the  least  uric  acid, 
and  it  is  at  the  same  time  one  of  the  most  nourishing  of  vege- 
tarian foods,  as  it  contains  JJ  per  cent,  of  carbohydrates. 

Thus  with  vegetarian  diet  we  can  avoid,  in  great  proba- 
bility, those  diseases  which  arise  from  an  excessive  formation 
of  uric  acid.  As  Professor  Dettweiler,1  of  Freiburg,  demon- 
strated at  the  German  Congress  of  Medicine  in  1907,  the  vis- 
cosity of  blood  is  greatly  diminished  by  a  vegetarian  diet.  As 
gout  is  a  disease  which  is  due,  in  all  probability,  to  a  retention 
of  uric  acid  (after  preliminary  changes  in  the  thyroid  and  kid- 
neys, as  we  have  pointed  out  in  a  communication  to  the  Paris 
Biological  Society,  February  25,  1907),  a  long  extended  vege- 
tarian diet  can  unquestionably  be  of  a  great  benefit  for  the  pre- 
vention and  treatment  of  this  disease.  It  is,  however,  necessary 
that  such  a  diet  should  be  prescribed  for  a  very  long  time  (for 
several  months  at  least)  if  we  desire  to  reap  the  full  benefit 
from  it. 

To  prevent  the  development  of  diabetes,  also,  especially  in 
cases  of  children  of  diabetic  parents,  a  vegetarian  diet  can  be 
of  great  use.  In  the  chapter  on  the  deleterious  action  of  ex- 
cessive meat  food,  we  refer  in  detail  to  the  fact  that  diabetes  is 
most  often  found  in  persons  addicted  to  much  meat  food,  espe- 

1  Dettweiler :     German  Congress  of  Internal  Medicine,  1905, 


Advantages  and  Disadvantages  of  a  J'egetarian  Diet.     311 

cially  if  carbohydrates  are  taken  in  large  quantities  at  the  same 
time.  Obesity  is  seldom  found  in  persons  who  live  on  a  vegeta- 
rian diet.  Carbohydrates  can  be  taken  in  large  quantities  without 
producing  obesity,  if  only  meat  is  not  taken  at  the  same  time  in 
more  than  a  limited  amount. 

Arteriosclerosis  is  very  seldom  found  in  persons  who  have 
been  addicted  for  many  years  to  vegetarianism.  Not  only  is 
this  due  to  the  fact  that  a  vegetarian  diet  is  the  least  deleterious 
to  the  circulatory  system,  but  as  we  have  mentioned  above,  the 
viscosity  of  the  blood  is  also  diminished ;  but  with  a  vegetarian 
diet,  coupled  with  milk,  there  is  much  less  intestinal  putrefaction, 
if  any,  than  with  a  meat  diet.  It  is  well  known  that  the  produc- 
tion of  arterial  sclerosis  can  be  facilitated  by  the  products  of 
intestinal  putrefaction. 

As  Brissaud  and  Siccard  have  shown,  the  injection  of  ad- 
renalin and  uric  acid  at  the  same  time  into  animals  produces 
atheromatosis  in  each  case.  We  also  know,  from  clinical  ob- 
servation generally,  that  arteriosclerosis  is  of  greater  frequency 
among  gouty  people,  and  the  frequency  of  diabetes  among  such 
can  be  attributed  to  arteriosclerotic  changes  in  the  pancreas 
(endarteritis  obliterans,  Flexner). 

Marcel  Labbe  has  shown  at  the  French  Congress  of  Inter- 
nal Medicine  in  Paris,  1907,  that  a  diet  of  cereals,  milk,  butter, 
and  sugar  diminishes  the  quantity  of  uric  acid,  while  the  addi- 
tion of  nucleo-albumins  augments  it. 

Vegetarian  diet  is  of  great  service  to  the  intestines,  their 
torpidity  being  thereby  greatly  overcome ;  and  if  milk  be  taken  at 
the  same  time  intestinal  putrefaction  is  checked  and  the  tendency 
to  catarrh  improved.  Such  a  diet  is  also  of  great  value  to  other 
important  organs:  the  thyroid,  liver,  and  kidneys;  as  in  cases 
where  such  are  in  a  diseased  condition,  the  chances  of  recovery 
or  for  a  more  prolonged  life  are  much  enhanced,  because  such  a 
diet  is  least  harmful  to  these  organs. 

But  the  greatest  advantages  of  a  vegetarian  diet  are  seen 
in  the  prevention  of  the  ravages  of  old  age  by  this  means.    By  the 


312  Old  Age  Deferred. 


use  of  such  a  diet  we  can,  to  a  certain  extent,  check  the  degen- 
eration of  those  organs  which  play  the  most  important  patho- 
logical roll  in  the  development  of  old  age,  and  which  have 
already  been  mentioned  several  times,  viz. :  the  thyroid,  liver, 
and  kidneys  (see  the  hygiene  of  these  organs).  The  degenera- 
tion of  these  may  produce  the  retention  of  toxic  products  and  a 
condition  of  autointoxication;  but  by  a  vegetarian  diet,  coupled 
with  milk,  these  troubles  may  be  more  easily  avoided. 

A  vegetarian  diet,  with  milk  and  a  few  eggs  daily,  is  the 
best  nourishment  for  old  people;  the  greater  the  age  the  more 
of  the  latter  should  be  taken.  In  fact,  persons  advanced  in  age 
will  do  well  to  eat  very  little  meat,  for  reasons  which  are  fully 
given  in  the  chapter  on  the  dangers  of  a  too  abundant  meat  diet. 

We  have  thus  seen  that  a  vegetarian  diet  can  give  the  best 
results,  not  only  in  the  prevention  and  cure  of  many  diseases,  but 
also  in  the  preservation  of  health  in  old  age.  It  is  a  fact  that  we 
often  see  persons  who  follow  such  a  diet  looking  much  fresher 
and  more  youthful  than  those  who  partake  of  much  meat,  espe- 
cially when  they  have  passed  the  seventies. 

But  if  milk  and  vegetarian  diet,  with  a  few  eggs  daily,  can 
be  taken  for  many  years  and  yield  good  results,  it  is  quite  a 
different  case  with  those  people  who  are  in  the  habit  of  living 
only  on  vegetables  to  the  exclusion  of  any  article  of  animal  food ; 
such  are  vegetarian  fanatics,  and  if  they  keep  up  this  deleterious 
habit  for  a  lengthened  period,  they  must  inevitably  suffer  for  it. 

Even  if  we  do  not  admit  the  pretensions  of  certain  authors, 
who  declare  that  the  albumin  of  the  vegetable  is  less  nourishing 
than  the  albumin  of  animals,  still  it  is  impossible  for  us  to  intro- 
duce into  our  bodies  the  quantity  of  vegetables  which  would 
contain  the  number  of  calories  necessary  in  order  that  we  should 
not  suffer  from  a  deficiency  of  them,  and  at  the  same  time  would 
allow  for  waste.  To  satisfy  the  requirements  of  our  bodies  we 
would  have  to  eat  enormous  quantities  of  vegetables  and  thus 
overload  the  stomach  and  intestines,  with  the  result  that  even  the 
strongest  stomach  would  undoubtedly  give  way  after  a  certain 


Advantages  and  Disadvantages  of  a  Vegetarian  Diet.     313 

time,  and  dyspepsia,  especially  sour  stomach,  and  eventually 
atony,  and  in  many  cases  even  dilatation,  of  the  stomach  would 
follow;  and  abnormal  fermentation  would  readily  take  place  in 
the  intestines  after  a  certain  time.  Consider,  also,  what  large 
amounts  of  enzymes,  how  much  saliva,  hydrochloric  acid,  bile, 
etc.,  must  be  produced  in  order  to  insure  a  good  digestion  and 
assimilation  of  the  food,  though  it  is  of  course  true  that  the 
ferments,  at  least,  can  readily  act  in  a  very  small  degree  upon 
large  quantities  of  food.  Vegetarian  diet  has  also  the  drawback 
that,  for  reasons  already  mentioned,  more  salt  must  be  taken 
when  we  partake  of  it. 

There  are  many  people  who  develop  hyperchlorhydria  after  a 
vegetarian  diet,  and  we  frequently  had  to  have  our  patients  aban- 
don such  a  diet  when  they  .got  acid  stomachs;  and  they  only  re- 
covered from  these  ill  effects  after  animal  food  had  been  given 
in  certain  quantities.  It  is  certain  that  the  present  capacity  of 
the  stomach  and  intestines,  and  their  present  anatomical  and  his- 
tological structure,  also,  is  not  sufficient  or  adequate  for  the  con- 
tinued use  of  a  vegetarian  diet,  the  greatest  danger  of  which  lies, 
however,  in  the  threatening  under-rmtrition,  and  in  consequence 
the  imminent  danger  of  bacterial  infection. 

It  is  a  positive  pathological  fact  that  under-nutrition  (or 
defective  nutrition)  through  lack  of  the  necessary  amount  of 
proteids  in  the  diet  exposes  one  more  to  infection  by  bacilli. 
This  is  plainly  to  be  seen  every  day,  especially  in  regard  to  tuber- 
culosis; and  as  the  best  preventive  to  this  we  strongly  recom- 
mend plenty  of  nutrition,  especially  rare  meat  and  milk.  We 
have  personal  knowledge  of  several  cases  of  tuberculosis  arising 
from  a  purely  vegetarian  diet  (see,  also,  Chapter  III).  The 
findings  of  Grawitz2  indicate  that  an  insufficient  proteid  diet  pre- 
disposes also  to  anaemia.  The  importance  of  this  fact  is  empha- 
sized by  Sajous  who  has  shown  (1903)  that  defective  nutrition 
weakens  the  activity  of  the  pituitary,  thyroid  and  adrenals,  the 


2  Grawitz:     "Klinische  Pathologie  des  Blutes."  third  edition,   1906. 


314  Old  Age  Deferred. 


products  or  secretions  of  which  take  an  active  part  in  the  destruc- 
tion of  bacteria  and  their  tocsins. 

In  our  chapter  on  the  destruction  of  toxic  products  by  the 
liver,  we  referred  to  evidence  gained  from  actual  experiments, 
that  under-nutrition  predisposes  to  infection.  We  have  referred 
to  Roger  and  Gamier,  who  have  proved  that  the  liver  loses  its 
antitoxic  properties  in  cases  of  under-nutrition,  and  it  is  prob- 
able that  the  other  antitoxic  organs  exhibit  a  similar  condition. 

There  art  two  primary  conditions  on  which  infection  de- 
pends:  i.  The  invasion  of  the  microbes.  The  greater  their 
number  and  virulence  the  more  easily  will  infection  take  place. 
2.  The  diminution  of  our  normal  resistance  against  infection, 
which,  as  we  have  seen  in  the  third  chapter,  can  be  caused  by 
different  factors,  among  which  is  under-nutrition. 

In  any  case  we  are  surrounded  by  countless  millions  of 
microbes  every  day,  which  are  only  too  anxiously  awaiting  a 
favorable  moment  to  attack  us ;  and  should  we  be  so  foolish  as  to 
encourage  their  attacks  by  adopting  fads  in  our  nourishment? 

The  greatest  danger  of  a  strictly  vegetarian  diet  is  for  those 
persons  whose  parents  suffered  from  chronic  cachectic  diseases, 
such  as  tuberculosis,  chronic  alcoholism,  etc.,  in  whose  cases  the 
perils  of  infection  are  much  more  menacing.  Should  such  ex- 
pose themselves  still  more  by  insufficient  nourishment,  such  a 
course  can  be  called  by  no  other  name  than  culpable  negligence, 
leading  to  suicide.  It  is  the  object  of  this  book  to  demonstrate 
the  best  way  to  reach  a  ripe  old  age  and  to  avoid  disease ;  it  is, 
therefore,  my  duty  to  emphasize  the  dangers  of  a  sole  vege- 
tarian diet,   especially  for  weak  people. 

As  the  processes  of  oxidation  are,  as  a  rule,  diminished  in 
old  age,  especially  in  its  advanced  stage,  such  persons  can  exist 
on  less  food  and  need  not  introduce  so  many  calories  into  their 
system;  and  as  they  also  take  less  exercise,  so  they  require  less 
nourishment.  Consequently,  they  can  live  better  on  a  vegetarian 
diet  than  can  the  young  and  robust.  Even  then,  however,  it  may 
be  prejudicial  to  their  health  to  live  solely  on  vegetables,  and  it 


Advantages  and  Disadvantages  of  a  Vegetarian  Diet.     315 

will  be  necessary  to  supplement  this  with  milk  and  a  few  eggs 
daily.  For  young  people  such  a  diet,  continued  for  a  prolonged 
period,  will  present  evils,  and  it  would  therefore  be  advisable  not 
to  continue  such  nourishment  longer  than  four  or  six  weeks,  and 
then  add  meat  once  a  day  to  the  former  diet  of  vegetables.  This 
is  mixed  vegetarian  diet,  and  should  be  interposed  in  the  ordinary 
diet  routine  at  intervals  and  at  times  of  necessity.  Thus  when 
symptoms  of  over-nutrition  may  present  themselves  a  purely  vege- 
tarian regimen  may  be  followed,  but  not  for  longer  than  three 
or  four  weeks ;  but  for  those  having  a  weak  constitution  and  great 
tendency  to  infection,  a  purely  vegetarian  diet  is  not  indicated, 
even  for  so  short  a  time  as  a  week. 

Judging  from  my  own  personal  experience,  I  do  not  think 
it  possible  for  persons  who  confine  themselves  solely  to  a  vege- 
table diet  to  prosper  and  look  well,  especially  if  they  exist  on  such 
insufficient  food  for  several  months,  and  still  less  so  if  they  con- 
tinue such  a  course  for  a  longer  time.  We  know  that  all  the 
people  of  our  acquaintance  who  existed  for  a  long  time  on 
such  a  diet,  presented  a  pale,  haggard  and  miserable  appearance, 
so  that  we  could  not  but  pity  them.  We,  personally,  tried  to  fol- 
low their  example,  but  after  a  short  experience  hunger  forced  us 
to  abandon  the  idea.  Even  long  and  careful,  mastication  did 
not  satisfy  our  craving  for  food,  so  that  we  had  to  add  milk, 
cheese,  and  eggs.  We  admit,  however,  that  for  those  of  an 
unhealthy  constitution,  requiring  less  food,  and  especially  for 
those  who  are  in  the  habit  of  overeating,3  there  may  be  found 
some  satisfaction  in  such  a  system  of  under-nutrition ;  but  even 
they  have  no  right  to  call  it  a  healthy  method  of  nourishment. 
We  have  found,  that  as  a  whole,  women  can  stand  more  easily, 
and  also  for  a  longer  time,  a  vegetarian  diet. 


3  As  an  illustration  we  may  mention  the  amusing  story  of  the  rich  Dutch- 
man, who,  while  en  route  to  an  Austrian  watering  place  for  the  treatment 
of  his  obesity,  was  arrested  in  Germany  for  some  imprudent  utterances  termed 
"lese  majeste,"  and  after  having  been  kept  in  prison  for  four  months  on  a 
largely  vegetarian  diet  came  home  as  a  slender  man  cured  of  his  corpulency. 


316  Old  Age  Deferred. 


Those  who  point  out  by  historical  facts  that  man  wag  des- 
tined to  vegetarian  diet  may  not  be  right,  for  it  is  certain  that 
many  thousands  of  years  ago  man  was  a  fruit  eater,  when  he 
also  lived  in  trees.  When  he  began  to  reside  on  terra  firma, 
compelled  to  so  do  by  the  scarcity  of  fruit  in  consequence  of 
the  increase  of  humanity,  he  turned  hunter  and  meat  eater. 
When  we  visit  ethnographical  museums,  we  find  that  from  10 
to  5000  years  before  Christ  man  fashioned  spear  heads  and 
knives  from  flint,  with  which  he  killed  animals,  upon  the  meat 
of  which  he  subsisted ;  and  at  such  times  he  lived  chiefly  on  meat 
and  fish,  only  later  becoming  agriculturist  and  omnivorous  in  diet. 

Many  believers  in  a  sole  vegetarian  diet  like  to  point  to  ani- 
mals as  an  example,  for  these,  they  maintain,  prosper  on,  and  are 
contented  with  herbs.  Let  us  follow  up  this  statement  and  see 
what  we  find  to  be  the  case  in  the  animal  world. 

We  maintain  that  the  truth  of  the  matter  is  that  there  are 
few  animals  of  the  nobler  kind  to  be  found  among  those  existing 
on  herbs.  We  find  the  monarchs  of  the  animals  among  the 
carnivorous  class,  and  if  we  take  them  as  our  example,  the  cour- 
age and  valor  of  the  lion  will  appeal  to  us  far  more  forcibly  than 
the  cowardice  and  helplessness  of  the  sheep. 

Energy  gained  by  the  addition  of  a  certain  amount  of  ani- 
mal food  does  not  exclude  the  nobler  qualities  peculiar  to  the 
human  brain,  freed  from  fads  and  fanaticism,  and  it  is  a  valuable 
factor  in  combating  the  numerous  vicissitudes  of  life. 


CHAPTER  XXXVIII. 

On  the  Dangers  of  a  Too  Abundant  Meat  Diet — A  Few 
Hints  on  the  Dietetics  of  Meat. 

Most  of  us  have  experienced  a  feeling  of  heaviness  after 
a  dinner  consisting  of  rich  meat,  and  not  infrequently  there  is 
also  a  sensation  of  drowsiness  after  it,  which  is  not  easy  to  over- 
come. The  first  may  be  due  to  the  difficulty  of  digestion;  but 
we  may  not  experience  this  after  taking  even  twice  as  much 
carbohydrate  and  green  vegetable  food.  We  know,  from  the 
observations  on  food  already  referred  to,  that  meat  is  far  more 
digestible,  unless  it  contains  much  connective  tissue  and  sinewy 
matter,  than  the  majority  of  cereals  and  green  vegetables,  and 
especially  fruit;  and  yet  after  a  dinner  of  the  latter  we  will  not 
feel  so  heavy  as  after  a  meal  in  which  we  have  taken  a  smaller 
amount  of  food,  but  of  which  the  greater  part  was  meat. 

This  feeling  of  heaviness  can,  therefore,  not  be  attributed 
to  difficulty  of  digestion,  and  as  there  is,  at  the  same  time,  a 
greater  disinclination  to  work  and  a  feeling  of  sleepiness  after 
a  meal  with  much  meat  than  after  one  of  vegetables  alone,  or  of 
milk  and  vegetables,  meat  must,  undoubtedly,  have  a  more  dele- 
terious effect  upon  the  central  nervous  system  than  have  other 
kinds  of  food. 

That  this  mere  clinical  observation  is  not  fallacious  is  also 
shown  by  the  fact  that  after  eating  much  meat  nervous  dis- 
orders are  far  more  frequent;  and  we  find  many  more  instances 
of  neurasthenia  and  hysteria  among  eaters  of  much  meat  than 
among  vegetarians ;  and  in  the  treatment  of  many  nervous  dis- 
orders far  better  results  are  obtained  after  excluding  meat  from 
the  diet. 

It  is  noticeable  in  a  marked  degree  in  Graves's  disease,  and 
also  in  myxoedema,  that  patients  suffering  from  them  will  not 

(317). 


318  Old  Age  Deferred. 


improve  with  meat,  and  after  partaking  of  it  their  symptoms 
are  aggravated.  This  is  only  natural,  as  these  diseases  are 
caused  by  changes  in  the  thyroid  gland,  to  which  we  have  referred 
in  Chapter  II,  where  we  have  also  shown  that  this  gland  under- 
goes changes  through  an  overabundance  of  meat.  We  have 
there  mentioned  the  very  interesting  experiments  of  Leo  Breis- 
acher,  of  Detroit,  and  of  Blum,  of  Frankfort,  and  others.  But 
we  would  wish  to  remark  here  that  it  has  been  demonstrated  by 
the  experiments  of  Chalmers  Watson,  of  Edinburgh,  that  when 
certain  animals,  such  as  fowls,  eat  much  meat  to  the  exclusion  of 
all  other  kinds  of  food,  they  present  great  enlargement  of  the 
follicles  of  the  thyroid  gland,  and  that  rats,  kept  on  the  same 
diet,  exhibit  even  a  degeneration  of  the  gland,  which  can  even  go 
to  the  extent  of  presenting  the  clinical  picture  of  Graves's  disease. 
Not  only  the  thyroid,  but  the  other  ductless  glands  also,  have  been 
found  altered  after  an  exclusive  meat  diet.  Forsyth1  found  also 
an  enlargement  of  the  follicles  of  the  pituitary  body  in  birds  of 
prey,  and  Houssaye2  found  that  chickens  lost  their  fertility  after 
such  a  diet,  which  affected  their  ovaries. 

There  are  numerous  clinical  and  anatomo-pathological  evi- 
dences to  show  that  the  other  ductless  glands  also — that  is,  the 
glands  with  internal  secretion,  such  as  the  liver,  kidneys,  and 
even  also  the  pancreas — are  altered  by  an  abundance  of  meat 
food  if  long  continued. 

We  have  already  dwelt  on  the  fact  that  the  liver  has  the 
function  of  destroying  the  harmful  products  that  are  formed 
by  the  decomposition  of  meat  food.  Thus  the  more  meat  we 
eat  the  more  work  is  thrown  on  the  liver,  which  may  first  be- 
come hypersemic,  but,  through  the  continuation  of  the  harmful 
agency  more  deleterious  conditions  may  develop.  Every  physi- 
cian can  observe  daily,  as  we  have,  that  when  patients  suffering 
from  disorders  of  the  liver  take  meat,  they  gradually  get  worse, 
but  when  they  give  up  meat  they  soon  get  better.     If,  therefore, 


i  Forsyth:     Lancet,  1907. 

2  Houssaye:    C.  R.  Academie  des  Sciences,  p.  934,   1903. 


The  Dietetics  of  Meat.  319 

we  desire  to  retain  our  vitality  for  a  long  time,  it  is  best  for  us 
not  to  take  too  much  meat. 

In  the  same  way  the  kidneys  can  also  be  kept  in  good  con- 
dition if  too  much  meat  be  not  taken.  These  eliminate  the  end- 
products  of  meat  food,  and  the  more  of  such  products  that  pass 
through  the  kidneys,  the  more  of  them  are  taken  from  the 
blood  and  excreted  by  means  of  the  fine  epithelia  of  the  kidney 
tubules,  and  thus  the  more  is  the  work  done  by  these  organs ;  and 
we  have  mentioned  that  any  over-work  of  an  organ  may  be  fol- 
lowed by  its  exhaustion.  As  a  consequence  of  eating  meat  some- 
times very  harmful  products  pass  through  the  kidneys,  especially 
in  the  case  of  preserved,  strongly  seasoned,  or  spiced  meat,  for 
such  preserved  food  may  contain  disease  germs,  ptomaine  bodies, 
mineral  poisons,  etc.  But  even  the  passage  of  normal  end- 
products  of  meaty  food — for  example,  if  urea  be  continually 
passed  for  years  in  large  quantities — can  produce  serious  altera- 
tions. Many  authorities,  such  as  Dr.  James  Tyson,  of  Phila- 
delphia, who  is  well  known  by  his  works  on  the  kidneys,  attribute 
to  the  very  frequent  taking  of  such  food  many  cases  of  interstitial 
nephritis;  and  nearly  all  such  authorities,  including  Senator,  of 
Berlin,  prohibit  the  use  of  meat  in  most  of  the  disorders  of  the 
kidneys.  But  we  have  already  referred  to  the  danger  of  such  a 
diet  to  the  liver  and  kidneys,  and  it  is  only  because  of  the  im- 
portance of  the  subject  that  we  have  again  referred  to  the  matter. 

There  is  some  clinical  evidence  in  favor  of  the  opinion  that 
the  pancreas  may  also  be  altered  by  an  abundant  meat  diet.  We 
know  that  when  this  organ  is  diseased  we  may  discover  a  quan- 
tity of  unabsorbed  meat  fibers  in  the  faeces,  indicating  that  the 
pancreas  has  failed  to  fulfill  its  task  of  assisting  in  the  digestion 
of  meat  by  the  production  of  its  ferment — the  trypsin.  Meat, 
when  taken  in  large  quantities,  can  thus  cause  the  pancreas  con- 
siderable overwork,  which,  in  the  long  run,  as  is  well-known, 
may  cause  trouble,  as  is  shown  by  the  fact  learned  from  observa- 
tion, that  diabetes  develops  generally  in  meat  eaters.  Even  in 
dogs  an  abundant  meat  diet  can  produce  spontaneous  diabetes,  a 


320  Old  Age  Deferred. 


fact  we  have  already  published.  Diabetes  may  not  only  be  due  to 
the  changes  in  the  pancreas,  but  also  as  we  have  shown2a  to  those 
in  the  thyroid  gland,  consequent  upon  such  nourishment. 

It  is  a  very  important  fact  that  much  meat  can  become  most 
injurious  to  diabetic  patients,  and,  as  v.  Noorden3  observed,  even 
slight  cases  of  diabetes  can  be  transformed  into  severe  ones 
in  consequence  of  such  a  diet ;  thus,  in  our  opinion,  in  all  severe 
cases  of  this  disease  meat  should  be  prohibited. 

Not  only  can  diabetes,  especially  if  of  an  hereditary  nature, 
be  increased  by  abundant  meat  food,  but  gout  also,  as  is  well 
known,  may  be  caused  thereby,  and,  existing,  may  be  made  worse. 
Such  diet  not  only  provokes  the  elimination  of  sugar,  but  of  uric 
acid  as  well,  which  latter  is  a  cause  of  gout. 

Many  authorities,  especially  Walker  Hall  and  Haig,  have 
demonstrated  that  even  small  quantities  of  meat  can  produce  uric 
acid,  especially  when  such  meat  contains  a  large  quantity  of 
nuclein  bodies  from  which  uric  acid  can  be  formed,  such  as  the 
glandular  organs,  especially  kidneys,  liver,  sweetbreads,  short- 
bread, etc. 

Meat  food  in  abundance  is  also  deleterious  to  other  organs, 
as,  for  instance,  to  the  intestines,  which,  receiving  a  food  so  easily 
digested  and  absorbed,  lack  the  natural  stimulus  for  good  peristal- 
tic movements,  which  can  best  be  produced  by  a  cellulose  food 
like  vegetables  and  fruit. 

The  greatest  danger  to  the  circulatory  apparatus  lies  in 
meat,  for,  as  already  mentioned,  the  viscosity  of  the  blood  is 
thereby  increased,  as  discovered  by  Determann,4  and  thus  its  cir- 
culation through  the  blood-vessels  impaired.  It  is  a  well-estab- 
lished fact  that  arteriosclerosis  can  very  often  be  observed  in 
persons  who  have  been  largely  addicted  to  a  meat  diet  for  a  long 
time.     Apoplexy  also  is  more  frequent  among  such. 


2a  Lorand :      "Die    rationelle    Behandlung    der    Zuckerkrankheit,"    second 
edition,  Berlin,  1909. 

3  v.  Noorden:     Deutscher  Naturforscher  Congress,  1902. 

4  Congress  fiir  Innere  Medicin,  1904. 


The  Dietetics  of  Meat.  321 

These  conditions  can,  however,  be  improved  if  the  meat 
be  suppressed  and  replaced  by  a  vegetarian  diet. 

It  would  lead  us  beyond  the  limits  of  this  book  if  we  at- 
tempted to  point  out  in  an  exhaustive  manner  various  other 
dangerous  consequences  of  a  too  abundant  meat  diet.  All  we 
desire  is  to  discuss  the  question  whether,  in  view  of  the  various 
dangers  to  which  a  meat  diet  may  lead,  to  which  we  have  re- 
ferred, we  should  or  should  not  give  up  meat. 

We  think  we  should  be  guilty  of  fanatical  prejudice  if, 
because  of  the  above  accounts  of  the  dangerous  consequences 
ensuing  on  an  unlimited  abuse  of  meat,  we  should  discard  meat 
entirely,  even  in  small  quantities.  Such  a  course  is,  indeed, 
strongly  advocated  by  Haig,5  but  we  cannot  follow  him  so  far. 

It  is  quite  true  that  even  a  moderate  amount  of  meat  may 
create  uric  acid,  but  there  is  not  one  hour  out  of  the  twenty-four 
that  we  do  not  produce  a  small  amount  of  uric  acid  in  our  sys- 
tem, even  if  we  exclude  food  of  every  description,  such  being  the 
uric  acid  produced  endogenously  through  the  decomposition  of 
the  nuclein-containing  albuminous  bodies  in  the  system,  and 
which  it  is  hardly  possible  to  avoid;  and  if  our  kidneys  be  in 
good  condition  they  will  easily  eliminate  this  small  amount. 

Should  we  therefore  prohibit  a  person  of  50  or  60,  who 
has  been  in  the  habit  of  eating  meat  every  day  of  his  life  since 
childhood,  and  who  is  in  quite  a  normal  state  of  health,  from 
taking  a  moderate  amount  of  meat  once  a  day,  and  thus 
knock  him  out  of  all  his  old  habits  ?  We  do  not  think  this  would 
be  a  wise  proceeding  on  the  part  of  any  physician  of  wide  clinical 
experience  and  of  unprejudiced  mind,  as  everyone  must  have 
observed  that  such  a  radical  change  in  the  habits  of  a  lifetime 
may  lead  to  consequences  unfavorable  to  the  general  health. 
No!  We  desire  to  be  temperate  ourselves  and  to  preach  mod- 
eration. We  must  bear  in  mind  that  it  is  the  immoderate  use 
of  meat  that  is  to  be  condemned,  and  not  its  use  in  small  quan- 


5  Haig:     "Uric  Acid  in  the  Causation  of  Disease,"  sixth  edition,  London, 
1904. 

21 


322  Old  Age  Deferred. 


tities.  We  may,  therefore,  allow  a  moderate  amount  of  meat, 
once  a  day,  well  cooked  to  destroy,  if  possible,  certain  harmful 
matters  which  can  be  rendered  innocuous  by  sufficient  cooking; 
and,  by  preference,  we  recommend  boiled  meat,  as  such  food  has 
all  the  nourishing  properties  of  roast  meat  but  less  extractive 
substances,  which  might,  perhaps,  irritate  the  kidneys.  Fresh 
meat  should  be  taken  in  preference  to  canned  food,  as  in  the  latter 
at  times  there  is  present  certain  additional  matter,  such  as  pre- 
servative salts,  boracic  acid,  etc. 

White  meat  is  always  preferable  to  red,  although  it  is  the 
pretension  of  Offer  and  Rosenquist  that  in  their  action  both  kinds 
of  meat  are  similar;  still,  for  clinical  reasons,  we  agree  with 
Professor  Senator6  who,  from  his  experience,  considers  white 
meat  better  for  the  kidneys.  The  correctness  of  this  opinion  has 
been  proved  recently  by  the  researches  of  Max  Adler.6a  We  have 
seen  the  sugar  disappear  from  the  urine  of  our  diabetic  patients 
when  they  were  placed  upon  a  diet  poor  in  extractive  substances, 
such  as  fish  (except  salmon  and  carp),  veal,  etc.,  and  vegetables 
poor  in  carbohydrates;  indeed,  after  such  a  diet  they  were  able 
to  tolerate  quantities* of  carbohydrates  without  eliminating  sugar. 
It  is  also  of  importance  to  remember  that  meats  containing  many 
extractive  substances,  or  broths  made  from  such  meats,  are 
capable  of  greatly  increasing  the  blood  pressure ;  for  this  reason 
red  meats  should  be  forbidden  to  the  aged.^  The  meat  of  animals 
that  have  been  hunted  and  subjected  to  great  exhaustion  before 
death  should' not  be  used,  or  used  only  with  very  great  modera- 
tion. Meat  strongly  seasoned  and  spiced,  or  pickled,  should  also 
not  be  eaten.  Sausages  should  also  be  omitted  from  the  diet. 
We  must  also'  remember  that  fish  is  also  a  meat  food,  although  on 
account  of  the  greater  amount  of  water  it  contains  and  its  more 
tender  structure,  and  especially  because  of  its  smaller  content  of 
extractive. substances  (except  salmon,  carp,  etc.),  it  is  preferable 
to  meat  proper;  yet  if  taken  in  large  quantities,  especially  such 


6  Senator :     "Die  Erkrankungen  der  Nieren,"  Nothnagel's  Handbueh. 
6aAdler:    Berliner  klin.  Wochenschrift,  1908. 


The  Dietetics  of  Meat.  323 

fish  as  salmon,  it  is  quite  as  harmful  as  meat.  At  any  rate  fish, 
except  the  red-fleshed  kind,  should  always  be  preferred  to 
ordinary  meat. 

It  is  best  not  to  give  meat  to  little  children  nor  to  per- 
sons in  advanced  years — above  70,  or  earlier  than  this  if 
they  are  decrepit.  As  found  by  Baumann,7  Charrin,8  Lafa- 
yette Mendel,9  and  others,  the  thyroid  of  infants  contains  no 
iodine;  after  the  first  year  there  is  some,  but  even  then  very 
little.  Baumann  and  Jollin10  also  found  that  the  thyroid  of  old 
people  contained  only  little  iodine,  which,  as  this  is  the  main  ele- 
ment of  the  thyroid  gland,  gives  to  such  persons  less  chance  of 
destroying  toxic  products ;  and  by  reason  of  this  no  meat  should 
be  given  either  to  little  children  or  to  persons  of  advanced  age. 

We  must  also  remember,  as  already  mentioned,  that  pro- 
teid  food  is  needed  to  build  up  the  body,  and  this  is  not  neces- 
sary in  senility.  All  authorities  agree  that  aged  people  require 
very  little  proteid  in  their  food,  and  Prof.  Magnus  Levy11 
accepts  this  opinion.  There  is,  consequently,  no  necessity  to 
force  them  to  take  meat,  neither  is  it  rational  to  permit  its 
use,  for  they  are  more  defenseless  against  the  harmful  products 
formed  by  the  decomposition  of  meat  than  are  younger  people,  for 
their  thyroids  and  parathyroids,  liver  and  kidneys,  are  degen- 
erated. Thus  they  would  be  able  neither  to  destroy  such  products 
nor  to  eliminate  them  from  the  body.  Exception  may  be  made 
in  the  case  of  the  aged  who  are  in  robust  health  and  enjoying  a 
green  old  age,  for  in  such  we  may  expect  to  find  more  active 
ductless  glands,  and  they  will  therefore  be  better  able  to  resist 
the  dangers  of  meat  food. 

There  are  certain  precautionary  measures  that,  perhaps,  can 
mitigate  such  dangers;  thus,  by  the  daily  use  of  water  in  pro- 


7  Baumann  and  Ross:   Zeitschrift  fur  Phys.  Chemie,  21-319,  1895:   22-1, 
1896. 

8  Charrin  et  Bouriet:     C.  R.  Soe.  biologie,  c-2-339. 

9  L.  Mendel :     Journal  of  American  Medical  Assn.,  3-2-'85. 

10  Jollin:     Nord.  Med.  Arch.,  1897,  Test  number. 

11  Magnus  Levy:     v.  Noorden,  "Pathologie  der  Stoffwechsels,"  i,  472. 


324  Old  Age  Deferred. 


portion  to  the  amount  of  meat  the  end-products  of  the  meat 
can  be  washed  away.  We  should  also  with  much  meat  eat  also 
much  fruit  and  vegetables.  Abundant  meat  diet  produces  acids 
in  the  system;  but,  as  mentioned  in  Chapter  X,  by  means  of 
green  vegetables  we  can  raise  the  alkalinity  of  the  blood. 
Whether  much  or  little  meat  be  taken,  sour  milk,  kefir,  yogurth, 
or  even  ordinary  milk  and  cheese  should  be  taken  also.  We  have 
not  mentioned  here  another  danger  from  meat  diet,  which  is  the 
putrefaction  that  may  arise  in  the  intestines,  but  on  which  we 
have  enlarged  in  Chapter  XIX.  By  means  of  sour  or  ordinary 
milk,  or  cheese,  the  putrefaction  can  be  avoided,  through  the 
lactic  acid  formed. 

With  a  meat  diet,  especially  when  taken  in  large  quantities, 
it  is  obvious  that  a  good  cleansing  of  the  bowels  will  be  all  the 
more  necessary,  and  this  is  best  obtained  by  the  addition  to  such  a 
diet  of  fruit,  vegetables,  and  sour  milk. 

By  precautions  such  as  these  the  harm  from  a  too  abundant 
meat  diet  may  be  reduced  or  at  least  limited ;  but  for  those  who 
are  desirous  of  attaining  an  advanced  old  age,  the  greatest 
moderation  in  the  matter  of  meat  consumption  is  strongly  rec- 
ommended. 

When  we  study  the  nature  of  the  diet  enjoyed  by  persons 
who  have  lived  to  and  over  ioo,  we  find,  indeed,  exceedingly 
few  who  are  great  meat  eaters;  very  many  are  persons  who 
eat  no  meat  at  all;  and  in  many  cases,  also,  the  original 
meat  diet  was  subsequently  abandoned  in  advanced  age.  Ac- 
cording to  the  report  of  the  Collective  Investigation  Committee 
of  the  British  Medical  Association,  the  55  centenarians  whose 
cases  they  examined  were,  for  the  most  part,  small  meat  eaters.12 


12  Quoted  after  Humphrey. 


CHAPTER   XXXIX. 

On  the  Great  Advantages  of  Much  Milk  in  the  Diet  for 
the  Prevention  and  Treatment  of  Old  Age. 

We  have  often  observed  that  patients  taking  large  quanti- 
ties of  milk  daily,  together  with  eggs  and  vegetables,  and  little 
meat,  soon  begin  to  look  better,  and  sometimes  even  younger. 
We  have  also  observed  upon  ourselves  the  great  advantage  of 
such  a  diet  in  comparison  with  other  diets. 

It  is  not  surprising  that  persons  using  large  quantities  of 
milk  daily  look  fresher  and  younger  if  we  consider  that  when 
we  take  much  fresh  raw  milk  we  are  also  taking  extracts  of 
various  ductless  glands,  and  especially  of  the  thyroid. 

It  has  been  shown  by  Bang,1  Mosse,2  and  others,  that  the 
internal  secretion  of  the  thyroid  passes  into  the  milk.  There 
are,  indeed,  several  facts  which  prove  that  thyroid  secretion  is 
contained  in  the  milk.  As  we  know,  the  iodine  in  our  body 
comes  mainly  from  the  thyroid,  which,  of  all  organs,  is  the  rich- 
est in  iodine.  Now  there  can  be  no  doubt  that  iodine  enters 
the  milk,  for  when  we  give  iodine  to  the  mother  it  can  pass,  by 
way  of  the  milk,  into  the  infant.  As  the  thyroid  of  the  infant, 
or  of  puppies,  contains  very  little  or  no  colloid  substance,  upon 
which,  as  shown  by  R.  Hutchison  and  Oswald,  the  quantity  of 
iodine  depends,  they  must  receive  the  iodine  from  the  maternal 
milk.  Mario  Flamini  (Revue  mensuelle  des  maladies  de 
l'enfance,  20,  97-120),  by  injecting  iodipin  into  a  goat,  obtained 
milk  containing  as  much  as  0.12  gramme  iodine  to  the  liter. 
Another  very  important  fact  is  that  children  suffering  from  con- 
genital myxcedema  never  show  any  symptom  of  this  condition 


1  Bang:      "Ueber   die  Aurscheidungs   des   Jodothyrius   durch   die  Milch,' 
Berl.  klin.  Wochenschrift,  Dec.  27,  1897. 

2C.  R.  de  l'Academie  de  Medicine,  1898. 

(325) 


326  Old  Age  Deferred. 


so  long  as  they  are  taking  their  mothers'  milk;  but  as  soon  as 
they  are  weaned  symptoms  of  myxoedema  appear,  which  we 
must  logically  ascribe  to  want  of  thyroid  secretion. 

Another  fact,  upon  which  we  would  like  to  insist,  is  that 
when  we  extirpate  the  thyroid  gland  of  goats  or  other  animals, 
their  milk  contains  (as  shown  by  Professor  Lanz  in  the  case  of 
goats)  a  substance  which  acts  upon  the  thyroid  gland,  dimin- 
ishing its  activity.  Logically,  we  think,  we  may  conclude  that 
the  milk  of  goats  with  intact  thyroids  must  contain  a  substance 
antagonistic  to  the  substance  contained  in  the  milk  of  thyroidless 
goats.     Such  a  substance  is  the  thyroid  secretion. 

Besides  thyroid  secretion  the  milk  also  contains  important 
nutritive  substances,  like  albumin,  milk  sugar,  and  fat;  also 
lecithin,  etc.,  certain  ferments,  and  mineral  matters,  as  lime, 
magnesia,  iron,  etc.  (see,  also,  chapter  on  animal  food).  The 
valuable  ferments  which  facilitate  the  digestion  of  the  milk  are, 
however,  only  contained  in  raw  milk,  and  to  a  less  extent  in 
milk  which  is  heated  above  75 °  C.  Behring  has  shown  that  even 
this  temperature,  if  maintained  as  long  as  thirty  minutes,  is  apt 
to  deteriorate  the  milk.  Pasteurized  milk  that  is  never  heated 
above  yo°  C,  and  is  cooled  immediately  afterward,  contains  a 
considerable  amount  of  these  important  ferments.  But  if  milk  is 
heated  to  higher  temperatures,  as  happens  in  boiling,  the  fer- 
ments are  killed.  It  is  of  the  greatest  significance  that  raw  milk 
has  also  the  property  to  kill  microbes  to  a  certain  extent.  Thus 
Walter  Hesse  found  in  1894  that  the  microbes  of  cholera  died  in 
raw  milk.  In  experiments  he  has  made  recently  with  Hemp,3  it 
was  shown  that  raw  milk  of  certain  kinds  of  cattle  had  also  the 
property  to  kill  the  bacilli  of  typhoid  fever.  But  it  is  of  the 
utmost  importance  to  remember  that  these  bactericidal  properties 
of  raw  milk  are  destroyed  if  the  milk  is  heated  to  6o°  C. 
(1400  F.).  These  authors  have  found  that  refrigerated  milk, 
even  if  it  is  cooled  down  from  70  °  C,  does  not  lose  its  bactericidal 
properties.  * 

3  Hemp :      Verhandlungen   des   Congresses    Deutscher   Naturforscher   und 
Aertze,  Dresden,  vol.  i,  p.  112,  1907. 


The  Advantages  of  Milk  in  Old  Age.  327 

There  is  a  wonderful  difference  in  the  effects  of  boiled  and 
raw  milk.  Animals,  or  children,  never  thrive  so  well  on  boiled 
as  on  raw  milk.  Professor  Behring,  of  Marburg,4  has  shown 
that  animals  fed  on  milk  heated  to  a  high  temperature  never 
thrive  well.  Calves  have  been  reared  in  Marburg,  or  on  Bo- 
hemian or  Hungarian  farms,  on  boiled  milk,  and  others  on  raw 
milk.  Experiments  with  hundreds  of  such  calves  have  shown 
that  boiled  milk  is  not  a  suitable  food  for  them. 

In  children,  also,  we  can  see  the  bad  effects  of  using  boiled 
milk.  It  has  been  shown  by  many  authors  that  Barlow's  dis- 
ease and  rickets  may  be  due  to  drinking  overheated  milk,  espe- 
cially when  such  milk  is  not  fresh.  Behring  has  now  shown  by 
experiments  that  when  calves  are  fed  on  boiled  milk  they 
acquire  rickety  deformities  of  the  bones  and  scorbutic  conditions. 
The  majority  of  the  calves  died  from  exhausting  diarrhoeas,  just 
as  do  infants  in  large  cities. 

Thus  it  is  evident  that  we  should  always  use  raw  milk,  and 
only  when  there  is  doubt  as  to  the  origin  of  the  milk  should  we 
heat  it,  and  then  not  above  6o°  to  yo°  C.  (140  F.),  so  as  not  to 
destroy  all  its  valuable  properties.  Considering  the  enormous 
importance  of  this  question  for  the  public  welfare,  it  would  be 
advisable  to  put  all  establishments  for  the  supply  of  milk  under 
the  control  of  physicians  or  veterinary  surgeons.  As  the  welfare 
of  many  children  depends  upon  the  condition  of  the  cow  that 
is  giving  them  its  milk,  cows  should  be  kept  with  great  care  and 
regarded  as  a  kind  of  wet  nurse.  Just  as  prisoners,  or  men  who 
work  all  day  in  close  and  badly  ventilated  rooms,  are  apt  to 
develop  tuberculosis;  so,  also,  are  cows  if  they  are  kept  in  dark 
stables  with  no  fresh  air.  Therefore  cows  should  be  let  out  to 
pasture  on  the  meadows  every  day,  and  kept  there  at  night  if  the 
weather  permits.  The  milk  is  also  improved  in  quality  if  the 
cow  gets  some  food  rich  in  proteids  in  addition  to  his  grain  and 
hay.  Every  cow  should  be  tested  by  tuberculin  injections,  and 
if  this  is  positive  the  animal  should  be  destroyed.     The  milking 

4  Behring:     Beitrage  ziir  experimentellen  Therapie,  8  fl,  1906. 


328  Old  Age  Deferred. 


of  the  cows  should  be  done  with  scrupulous  cleanliness.  The 
udders  and  surrounding  parts  should  be  washed,  and  the  milkers 
themselves  should  be  dressed  in  clean  white  clothes,  and  their 
hands  should  be  clean,  preferably  by  washing  them  with  some 
antiseptic  liquid.  Unless  the  cow  is  tubercular  or  otherwise  sick, 
its  milk  never  contains  any  harmful  substances.  As  soon  as  it  is 
obtained  the  milk  should  be  put  into  an  ice  chest,  as  this  is  the 
best  way  to  preserve  it,  and  air  should  be  excluded.  It  has  been 
shown  that  milk  cooled  off  to — 1600  C.  does  not  lose  its  good 
qualities,  and  can  be  kept  in  fresh  condition  for  many  days. 

By  undergoing  acid  fermentation  milk  does  not  lose  its  valu- 
able properties.  Important  substances  like  lecithin,  iron,  lime, 
native  albumin,  and  valuable  ferments  are  contained  in  such  milk. 
Whey  and  buttermilk  are  also  milk  foods  of  the  highest  value. 

Besides  its  contents  of  internal  secretions,  valuable  ferments, 
and  mineral  matters,  milk  must  also  be  considered  as  an  ideal 
form  of  nourishment  owing  to  the  fact  that  it  contains  all  the 
necessary  elements  of  human  food.  It  is  the  most  nourishing  of 
all  foods  since  it  contains  albumin,  fat,  and  carbohydrates,  the 
three  main  elements  of  human  food,  in  large  quantity.  Good 
cows'  milk  contains  about  35  grammes  of  albumin,  40  grains  of 
milk  sugar,  and  35  to  40  grammes  of  fat  to  the  liter.  Thus  if  a 
person  takes  2  liters  of  milk  a  day,  or  even  less,  3  to  4  eggs,  a  little 
butter  and  several  rolls,  he  can  live  comfortably  without  meat. 
We  have  made  an  experiment  on  ourselves  by  taking  13/2  liters 
of  milk,  4  eggs,  2  rolls,  and  20  grammes  butter  a  day  as  our  only 
food,  and  after  two  weeks  of  such  a  diet,  with  a  bodyweight 
of  68  kilos,  we  felt  very  well,  and  even  lost  no  weight  at  the 
end  of  the  trial.  We  have  found  in  our  own  case,  and  in  many 
patients,  that  with  one  plate  of  meat  at  dinner,  together  with 
vegetables  and  the  above  diet,  with  cheese,  it  is  possible  to  live 
prosperously  for  months  and  to  increase  considerably  in  weight. 
The  rosy  cheeks  of  persons  living  on  such  a  diet  are  the  best 
proof  of  its  efficiency. 

Those  who  do  not  like  milk  in  large  quantity  may  add  a 


The  Advantages  of  Milk  in  Old  Age.  329 

little  cocoa,  or  a  little  weak  coffee  to  it.  For  those  whose  stom- 
achs cannot  tolerate  pure  milk,  a  milk  obtained  by  fermentation 
— kefir — is  indicated.  This  can  be  prepared  by  fermenting 
cows'  milk  with  grains  of  kefir.  It  should  not  be  fermented, 
for  most  purposes,  for  longer  than  one-half  a  day.  By  virtue 
of  the  carbonic  acid  which  it  contains  it  has  a  soothing  action 
upon  the  walls  of  the  stomach,  and  also  promotes  a  better 
flow  of  gastric  juice.  Thus  it  is  more  easily  digested  than  ordi- 
nary milk,  whose  valuable  properties,  however,  it  retains. 

Milk  is  also  of  value  when  taken  in  large  quantity,  since  it 
checks  the  formation  of  bacterial  and  toxic  products  in  the  intes- 
tine, which,  as  we  know,  is  enormously  rich  in  such  products, 
especially  after  having  eaten  animal  food,  like  meat.  Milk  sugar 
and  lactic  acid  are  very  powerful  antiseptic  substances  probably 
the  best  natural  intestinal  antiseptics  of  which  we  know.  This 
fact  is  made  use  of  by  Metschnikoff  in  the  production  of  his 
lactobacilline,  by  which,  through  the  formation  of  milk  acid,  the 
multiplication  of  the  intestinal  bacilli  can  be  checked,  and  thus, 
according  to  Metschnikoff,  old  age  prevented  to  some  extent  (see, 
also,  Chapters  XIX  and  XX). 

It  is  a  very  interesting  fact  that  in  countries  where  much  of 
a  certain  kind  of  acid  milk  is  used  (e.g.,  Bulgarian  "yogurth," 
prepared  with  the  aid  of  the  Maya  bacillus),  there  are  many 
persons  who  live  to  be  more  than  ioo  (see  Chapters  VI  and 
XIX).  Some  of  the  long-lived  patriarchs  whom  we  mention  in 
this  book,  as  Parr,  who  has  lived  to  be  over  152  years  old,  lived 
mainly  on  a  milk  diet. 

In  addition  to  the  above-mentioned  properties  of  milk,  this 
food  has  also  the  great  advantage  of  throwing  the  minimum 
amount  of  work  upon  those  organs  whose  duties  are  concerned 
with  the  assimilation  of  food  and  the  elimination  of  its  waste 
products.  We  have  already  mentioned  that  animals  whose  thy- 
roids have  been  extirpated  can  only  survive  if  they  are  put  on  a 
milk  diet.      (Breisacher,5  Blum.6)     This  shows  that  when  the 

5  Breisacher :     Loo.  cit. 

6  Blum :     Loc,  cit. 


330  Old  Age  Deferred. 


thyroid  is  extirpated  or,  what  is  the  same  thing,  entirely  degener- 
ated, only  milk  food  can  be  tolerated,  for  the  poisons  of  other 
food,  like  meat,  are  normally  destroyed  to  a  great  extent  by  the 
thyroid  gland. 

In  old  age  there  is  greater  or  less  degeneration  of  the  thy- 
roid gland.  Just  as  is  the  case  with  infants,  whose  thyroids  are 
not  yet  developed,  so  also  old  people,  as  a  general  rule,  are  more 
helpless  against  poisons  formed  by  the  decomposition  of  meat. 
For  such  persons  evidently,  just  as  for  infants,  milk  food  is  the 
best. 

Here,  again,  we  see  the  similarity  that  exists  between  in- 
fancy and  senility,  and  we  realize  the  truth  of  the  saying  that  in 
senility  we  return  to  childhood.  That  milk  is  the  best  food  to 
keep  the  thyroid  in  good  working  order  has  been  proved  by  the 
experimental  researches  of  Fordyce.7 

In  our  opinion  one  of  the  greatest  advantages  of  milk  as 
a  food  is  that  it  exacts  for  its  assimilation  so  little  work  from 
some  of  our  most  overworked  and  most  important  organs, 
like  the  stomach,  liver,  and  kidneys. 

It  is  certainly  a  boon  to  an  overworked  stomach,  which  is 
otherwise  normal,  when  we  prescribe  a  diet  of  raw  milk,  which, 
for  many  persons,  is  more  digestible  than  most  other  foods.  It 
is  a  fundamental  principle  in  the  treatment  of  old  age  to  give 
a  rest  to  those  organs  of  the  body  which  are  the  most  active. 
Such  a  rest  will  certainly  do  good  to  the  stomach,  especially 
in  the  case  of  heavy  eaters,  and  will  improve  its  vitality.  The 
same  maxim  holds  good  for  the  liver  and  kidneys. 

There  is  no  food  which,  with  the  same  nutritive  content, 
contains  so  few  harmful  toxic  products  as  milk.  Imagine  the 
difference  between  the  liver  or  thyroid  of  a  heavy  meat  eater, 
and  those  of  one  who  has  long  taken  mainly  milk.  The  experi- 
ments of  Chalmers  Watson8  and  of  Forsyth9  speak  volumes  on 
this  point. 

7  Fordyce:     British  Med.  Journal,  vol.  x,  p.  619,  1902. 

8  Chalmers  Watson :     hoc.  cit. 

9  Forsyth :     Loc.  cit. 


The  Advantages  of  Milk  in  Old  Age.  331 

Since  milk  food  contains  scarcely  any  products  harmful  to 
the  liver,  even  when  taken  in  large  quantities,  and  considering 
at  the  same  time,  the  antiseptic  action  of  milk  food  upon  the 
bacilli  in  the  intestines,  it  is  easy  to  understand  that  with  such 
a  diet  little  work  is  thrown  upon  the  liver,  and  its  tissues  are  not 
damaged.  We  have  been  surprised  to  see  how  well  patients 
with  liver  or  gall-stone  trouble  looked  after  a  diet  of  milk  and 
vegetables  for  several  weeks.  The  importance  of  such  a  diet 
upon  the  condition  of  the  bile  passages  is  shown  by  the  well- 
known  fact  that  inflammation  of  the  bile-ducts  and  gall-bladder 
can  be  caused  by  the  immigration  of  bacilli  from  the  intestine.  It 
follows  that  with  a  lessened  amount  of  intestinal  bacilli,  the  bile- 
passages  will  not  be  so  liable  to  infection,  and  by  a  milk  diet,  espe- 
cially one  of  sour  milk,  kefir,  koumiss,  etc.,  we  can  limit,  to  a  large 
extent,  the  number  of  bacteria  in  our  intestines.  Therefore  such 
a  diet  would  be  calculated  to  prevent  disorders  of  the  gall-ducts 
and  bladder  and  gall-stone  disease,  which  are  so  often  found  in 
elderly  persons. 

Milk  is  a  food  which  contains  scarcely  any  extractives. 
In  consequence  it  is  an  ideal  food  for  the  kidneys,  through  which 
it  passes  without  causing  the  least  injury  to  these  vital  organs, 
which  cannot  be  said  of  meat  with  its  numerous  extractive  sub- 
stances. Milk  contains  very  little  salt,  which  qualifies  it  as  a 
most  excellent  food  for  the  kidneys.  Milk  diet  has  rightly  been 
given  since  the  early  days  of  medicine  in  kidney  troubles.  Since 
in  old  age  there  is  an  increase  of  connective  tissue  in  the  kidneys, 
with  impairment  of  their  eliminative  capacity,  on  this  account 
also  milk  diet  is  the  most  suitable  for  old  persons. 

In  order  to  derive  the  greatest  possible  benefit  from  this 
most  excellent  food,  it  would  be  necessary  to  take  human  milk, 
as  thus  we  introduce  into  our  system  the  internal  secretions  of 
human  ductless  glands  and  human  ferments.  Such  good  for- 
tune can,  however,  only  fall  to  the  lot  of  infants,  and,  we  are 
sorry  to  say,  not  to  all  of  them.  Therefore  we  are  obliged  to 
use  the  milk  of  those  animals  which  is  next  best  to  human  milk 


532  Old  Age  Deferred. 


— for  example,  asses'  milk.  This,  however,  cannot  be  obtained 
easily;  two  pints  of  it  would  cost,  in  some  places,  about  a  dollar. 
The  next  best  substitute  is  goats'  milk,  which  also  contains  ten 
times  as  much  iron  as  cows'  milk.  It  is  a  great  puzzle  to  us  why 
the  milk  of  this  animal,  which  is  richer  in  fat  and  albumin  than 
cows'  milk,  is  not  more  used.  Perhaps  the  main  objection  is  the 
occasionally  disagreeable  smell,  which,  however,  can  be  avoided 
by  keeping  the  goat  very  clean.  The  goat  is  rarely  subject  to 
tuberculosis,  which  also  is  a  strong  argument  for  the  use  of  its 
milk. 

There  can  be  no  doubt  that,  for  those  who  can  stand  it  in 
large  quantities,  milk  is  an  excellent  aid  in  the  fight  against  old 
age  and  in  its  treatment.  As  most  constituents  of  the  blood 
enter  the  milk,  perhaps  it  is  not  too  daring  to  say  that  drinking 
milk  is,  in  a  measure,  drinking  blood.  Evidently  blood  contains 
all  the  internal  secretions  of  the  ductless  glands  as  well  as  most 
valuable  ferments ;  hence  the  rational  prevention  and  treatment  of 
old  age  would  consist  in  drinking  blood.  There  is,  however,  no 
general  tendency  to  such  bloodthirsty  methods  at  the  present 
time,  but,  maybe,  it  will  be  used  in  the  future.  But  if  we  cannot 
drink  blood  let  us  drink  milk,  the  most  valuable  food  there  is. 


CHAPTER   XL. 

On  Blood  as  an  Article  of  Food  Containing  Iron  and 
Animal  Extracts — Sausages  and  Blood  Puddings. 

Iron  is  a  most  important  element  of  our  blood,  the  lack 
of  which,  as  in  chlorosis  and  various  anaemic  conditions,  may 
produce  very  serious  symptoms.  To  replace  this  deficiency  iron 
is  introduced  into  our  system,  and  this  can  be  done  in  two  ways : 
either  by  the  natural  way,  i.e.,  by  food  which  contains  iron,  or 
artificially,  by  means  of  drugs  which  contain  iron.  It  is  the 
opinion  of  Bunge  that  iron,  given  in  drugs,  especially  as  inorganic 
iron,  is  not  so  readily  absorbed  and  assimilated  as  organic  iron, 
i.e.,  iron  as  it  occurs  in  various  articles  of  food,  and  especially 
in  the  blood. 

Therefore  an  effort  has  been  made  with  more  or  less  success 
by  manufacturing  chemists  to  make  preparations  of  iron  obtained 
from  the  blood,  and  Professor  Bunge1  has  experimented  on  ani- 
mals by  using  iron  containing  nuclein,  separated  from  the  yolk  of 
eggs ;  and  in  Professor  Kossel's  laboratory  such  a  preparation  has 
been  made  from  the  eggs  of  the  carp.  It  was  found  that  these 
preparations  were  perfectly  absorbed  and  assimilated. 

Professor  Bunge,  and  also  his  pupils  Abderhalden  and 
Hausermann,  found  that  all  animals  which  received  food  con- 
taining but  little  iron,  became  anaemic,  e.g.,  young  rabbits  fed 
only  on  milk,  which,  as  above  mentioned,  is  very  poor  in  iron. 
Later  food  was  given  that  contained  iron  (as  green  vegetables, 
cabbage,  herbs,  etc. ;  or  meat,  yolks  of  eggs,  and  fruit),  and  soon 
afterward  the  iron  contents  of  their  blood  was  found  to  be 
increased.  Even  if  we  are  not  anaemic  or  chlorotic,  it  is  necessary 
to  take  a  certain  amount  of  iron,  preferably  organic  iron,  into 
our  systems. 

Anaemia  of  slight  degree  is  very  frequent  in  women,  espe- 

l  Bunge:     Lehrbuch  der  Physiologie,  Berlin,  1907. 

(333) 


334  Old  Age  Deferred. 


daily  after  degeneration  of  the  ovaries,  as  after  the  menopause. 
As  we  have  already  mentioned,  the  ovaries  influence  in  a  remark- 
able way  the  condition  of  the  blood.  In  ..the  adult  the  bone 
marrow  is  the  chief  seat  of  formation  for  the  red  blood  corpus- 
cles ;  but  the  bone  marrow,  and  indeed  the  whole  skeleton,  as  we 
have  shown  in  the  second  chapter  of  this  book,  is  under  the  con- 
trol of  the  ovaries  and  of  the  thyroid.  As  these  organs  are,  as  a 
rule,  degenerated  in  old  age,  anaemia  must  result,  and  indeed  Prof. 
Naunyn2  says :  "Old  people  are  anaemic."  Geist  has  already 
emphasized  the  diminution  in  the  quantity  of  the  blood  in  old  age. 
That  blood  formation  is  deficient  in  old  age  is  demonstrated  by 
Besancon  and  Labbe,  who  found  the  activity  of  the  bone  morrow 
diminished  in  old  age,  and  by  Grawitz,3  who  found  that  bone 
marrow  underwent  important  changes  in  old  age,  being  trans- 
formed into  a  jelly-like  substance.  According  to  Grawitz,  iron — 
and  he  always  prefers  to  prescribe  an  organic  rather  than  an 
inorganic  iron  preparation — is  less  efficacious  in  old  age.  We 
attribute  this  to  the  degeneration  of  the  blood-forming  organs, 
through  whose  intermediary  action  iron  produces  its  effect.  If, 
however,  these  organs  are  not  entirely  degenerated,  but  only  par- 
tially so,  as  in  the  first  few  years  following  the  menopause — in 
women  until  the  end  of  the  fifties — we  can  obtain  better  results ; 
and  indeed  after  giving  such  women  iron  we  may  observe  that 
they  look  better,  and  often  fresher  (see,  also,  Chapter  LIII).  As 
organic  iron  is  more  easily  assimilated,  this  form  is  to  be  pre- 
ferred, and  the  question  arises :  How  should  we  take  it  ?  Of  all 
kinds  of  food  used  at  present,  spinach  and  the  yolk  of  eggs 
contain  the  most  iron;  so  we  could  give  these.  Fortunately 
spinach  is  obtainable  at  all  seasons  in  the  United  States.  For 
those  who  prefer  eggs,  yolks  in  quantities  large  enough  to  satisfy 
our  needs  would  not  be  easily  digested,  and  also  as  eggs  would 
be  difficult  to  procure  fresh  every  day,  we  must  think  of  another 


2  Naunyn:    In  Schwalbe's  Lehrbuch  der  greisenkrankheiten,  Berlin,  1909. 

3  Grawitz:    Hidem  and  also  in  "Klinische  Pathologie  des  Blutes,"  third 
edition,  Leipzig,  1906. 


Blood  as  an  Article  of  Food.  335 

expedient.  We  may  take  iron  preparations  obtained  from  the 
blood  of  animals.  But  why  not  take  the  blood  itself,  which 
contains  iron  in  a  form  similar  to  that  in  our  blood,  and  in  larger 
quantities  than  in  any  other  food  ?  This  would  certainly  be  more 
efficacious,  and  also  less  expensive. 

Bunge  mentions  that  the  chlorotic  girls  of  Basel  (Bale) 
come  to  the  slaughterhouses  in  order  to  drink  the  blood  of  ani- 
mals that  have  just  been  slaughtered.  The  question  arises  as  to 
which  animal's  blood  is  the  best.  That  of  the  pig  is  preferable 
for  several  reasons.  Its  blood  contains  much  iron  (according  to 
Bunge  226  milligrammes  in  every  100  grammes),  its  organs  are 
anatomically  and  histologically  very  like  our  own,  and  the  pig  is  an 
omnivorous  animal,  as  we  are,  being  able  to  eat  even  14  to  20 
pounds  of  meat  a  day.  Several  of  the  organo-therapeutic  prep- 
arations, like  ovarian  extracts,  and  testicular  and  kidney  extracts, 
are,  if  obtained  from  the  pig,  more  active  than  those  obtained 
from  other  animals.  And,  finally,  from  pigs'  blood  very  savory 
sausages  and  puddings  can  be  prepared. 

In  Denmark  and  Norway  a  favorite  pudding  is  prepared 
from  pigs'  blood,  together  with  flour,  sugar,  barley,  groats,  and 
raisins,  and  we  have  found  it  very  palatable.  In  these  countries 
many  physicians  prescribe  this  pudding  and  blood  sausages  (in 
England  called  "black  puddings")  to  chlorotic  girls. 

We  consider  pigs'  blood  to  be  of  very  great  value,  not  only 
on  account  of  its  iron,  but  also  because  it  contains,  as  does  blood 
in  general  (according  to  Claude  Bernard),  extracts  of  the  duct- 
less glands  in  their  most  assimilable  form,  and  by  taking  this 
blood  we,  at  the  same  time,  introduce  these  organic  extracts.  To 
obtain  the  greatest  possible  benefit  from  these  properties  the 
blood  should  be  drunk  fresh;  but  as  this  is  not  very  easy  to  do 
for  obvious  reasons,  we  can  substitute  blood  sausages  and  black 
puddings.  Blood  contains  chemical  substances  of  great  impor- 
tance, as  iron,  manganese,  phosphorus  and  small  quantities  of 
iodine,  besides  also  lecithin,  glycogen,  glucose,  jecorin,  etc.  It 
also  contains  important  ferments,  as  diastase,  and  sugar-  and  fat- 


336 


Old  Age  Deferred. 


splitting  ferments.     Likewise  it  contains  important  immunizing 
substances,  opsonins,  alexins,  etc. 

The  blood  of  pigs  is  very  nourishing,  for  it  is  rich  in  albu- 
min. Indeed,  considering  that  this  blood  is  wasted  in  the 
slaughter  houses,  it  is  necessarily  the  cheapest  kind  of  food. 
And  it  is  also  an  article  of  food  which  is  easily  digested,  ab- 
sorbed, and  assimilated.  It  is  hard  to  understand  why  this 
article  of  diet  has  not  been  made  more  use  of  long  ago.  Professor 
Bunge,  the  well-known  physiologist,  likewise  strongly  recom- 
mends the  use  of  blood  as  an  important  article  of  diet.  We  show 
in  the  following  table,  compiled  from  the  researches  of  Abder- 
halden,4  the  composition  of  pigs'  blood  and  of  ox  blood  in  respect 
to  their  nourishing  qualities  and  different  mineral  contents. 

Pigs'  Blood 

Water 71.6       per  cent. 

Haemoglobin 14.22 

Albumin 4.66 

Fat 0.11 

Fatty  Acids 0.04 

Sugar 0.069 

Cholesterin 0-044 

Lecithin 0.231 

Phosphoric  Acid  w.  Nuclein...  0.006 

Oxide  of  Iron 0.696 

Calcium 0.068 

Magnesium 0.089 

Potassium 0.2303 

Sodium 0.2406 

Entire  Phosphoric  Acid 0.1002 

Anorg.  Phosphoric  Acid 0.749 

Chlorides 0.2690 

According  to  the  researches  of  T.  Konig,5  Farwick  and  C. 
Kraut  blood  sausages  have  the  following  composition : — 


Ox  Blood 

80.89      per 

cent 

10.31        " 

(t 

6.98 

C( 

0.052      " 

It 

0.02        " 

It 

0.199      " 

u 

0.135      " 

" 

0.003      " 

t( 

0.054      " 

11 

0.007      " 

t( 

0.004      " 

it 

0.004      " 

u 

0.0364    " 

it 

0.0040    " 

It 

0.017      " 

4i 

In 

the  Natural  Substance 

Dry  Substance 

Water 

Nitro- 
genous 
Substance 

Fat 

Nitrogen 

Free 
Extract 
Matters 

Ashes 

Nitro- 
genous 
Substance 

Fat 

Nitrogen 
and  Dry 
Substance 

49.93% 

11.81% 

11.48% 

25.09% 

1.64 

23.59% 

22.90  % 

3.77% 

4  Abderhalden :    Zeitschrift  fiir  Physiolog.  Chemie,  1898,  25,  56   (for  pigs' 
blood)  ;    and  Hidem,  1897,  23,  521  (for  ox  blood). 

5  J.    Konig:     "Die    menschlichen    Nahrungs    und    Genussmittel,"    Berlin, 
1903,  I,  p.  76. 


Blood  as  an  Article  of  Food. 


Experiments  were  made  in  England  centuries  ago  by  trans- 
fusing the  blood  of  young  animals  into  the  veins  of  old  animals 
(sheep,  cows,  and  horses),  which  latter,  by  this  means,  became 
more  lively  and  active.  In  some  cases  the  special  senses  became 
more  acute — hearing  especially,  according  to  Dr.  Hufeland.  On 
man  such  transfusion  has  also  been  tried;  Dever  and  Riva,c  in 
Paris,  succeeded  in  treating  certain  diseases  by  transfusion  of 
animals'  blood,  and,  as  Hufeland  states,  a  lunatic  recovered 
his  health  after  transfusion  with  calves'  blood. 

It  is  strange  that  this  treatment  is  not  more  used  now. 
Should  we  not  be  able  to  treat  certain  diseases,  such  as  old  age, 
by  transfusing  the  blood  of  younger  individuals,  or  of  certain  ani- 
mals ?  This  is  certainly  a  bold  question,  and  we  are  not  yet  in  a 
position  to  answer  it  definitely.  We  must  take  into  considera- 
tion the  fact  that  the  transfusion  of  blood,  even  though  human, 
into  other  individuals  presents  certain  dangers.  Bier  has  tried 
transfusion  in  a  few  cases  of  lupus,  and  there  appeared  at  first 
symptoms  of  intoxication  followed  later  by  a  marked  ameliora- 
tion. But  if  transfusion  by  present  surgical  methods  is  not  free 
from  clangers  we  can  give  the  blood  in  a  more  rational  manner 
by  the  mouth.  As  Bunge  has  shown,  the  hsematin  is  absorbed  by 
the  intestines,  while  the  diapedesis  of  the  blood  corpuscles  them- 
selves through  the  intestines  has  been  demonstrated  in  the  experi- 
ments of  Grawitz.  The  serum  of  Moebius  (antithyroidin)  also 
acts  if  taken  by  the  mouth. 

At  the  present  time  nothing  hinders  us  from  using  the  blood 
of  pigs  in  the  way  just  mentioned.  But  care  must  be  taken  to 
obtain  fresh  and  healthy  blood.  Pigs  often  get  pneumonia 
through  catching  cold  during  transportation.  Therefore  those 
pigs  whose  blood  we  use  must  have  been  previously  specially 
examined. 

For  this  purpose  also  pigs  should  not  be  too  fat.  As  we 
learned  from  observations  in  the  slaughter  houses,  a  fat  pig  of 


6  Quoted  after  Hufeland,  Makrobiotik,  edited  by  Steinthal,  Berlin,  p.  13, 
1887. 

22 


338  Old  Age  Deferred. 


200  pounds  may  not  have  more  than  a  liter  of  blood,  whereas 
oxen  of  900  pounds  have  nearly  10  to  12  liters  of  blood.  Still, 
for  reasons  already  mentioned,  preference  should  be  given  to 
pigs'  blood. 

It  is  most  important  that,  when  the  diet  consists  of  much 
milk  and  little  or  no  meat,  some  iron-containing  food  be  taken 
in  addition. 


CHAPTER  XLI. 

Some  Remarks  on  the  Hygiene  of  Eating — How  to  Obtain 
an  Appetite — On  Mastication. 

If  we  desire  to  derive  benefit  from  what  we  eat  in  order 
to  keep  the  body  in  good  condition,  and  thus  successfully  resist 
the  onslaught  of  old  age,  we  must  possess  a  good  digestion  and 
be  able  to  make  use  of  our  gastric  juice.  Without  this  secretion 
all,  or  the  greater  part,  of  what  we  eat  will  remain  undigested  in 
the  stomach  and  intestines,  and  by  its  stagnation  produce  much 
disturbance  and  lessen  the  vitality  of  these  important  organs. 
Everything,  therefore,  depends  upon  being  provided  with  an 
adequate  supply  of  gastric  juice.  There  are  two  ways  of  aiding 
this :  First,  by  the  direct  action  of  the  food  on  the  walls  of  the 
stomach.  Second,  by  various  means  which  act  on  the  nervous 
system  that  governs  the  glands  of  the  stomach  and  provokes  their 
secretion.  As  by  the  first  means  only  a  small  amount  of  gastric 
juice  is  secreted,  we  will  deal  with  the  second. 

The  nerves  of  the  gastric  glands  can  be  stimulated  by  various 
agencies  which  influence  the  central  nervous  system,  and  thus 
provoke  appetite ;  for  instance,  sight,  for  we  know  of  old  how  the 
sight  of  tasty  dishes  provokes  our  appetite.  Professor  Pawlow, 
of  St.  Petersburg,  has  shown  by  experiments  on  dogs,  in  whose 
stomachs  he  had  made  a  fistula,  that  merely  showing  them  a  piece 
of  meat  was  sufficient  to  cause  them  to  secrete  a  large  quantity  of 
stomach  juice.  Umber  has  also  shown  on  man  that  optic  influ- 
ence was  able  to  produce  the  secretion  of  gastric  juice. 

In  addition  to  sight,  smell  produces  similar  results.  Pro- 
fessor Bickel,1  of  Berlin,  has  experimented  on  a  girl  of  23,  who, 
after  an  injury  from  caustic  potash,  had  to  have  a  fistulous  open- 


1  Congress  fur  Iimere  Medicin,  1904. 

(339) 


340  Old  Age  Deferred. 


ing  made  into  her  stomach,  her  oesophagus  being  completely 
strictured.  By  holding  steaming  hot  soup  under  her  nose  he 
caused  the  secretion  of  a  clear  stomach  juice  to  run  through  the 
open  fistula. 

The  secretion  of  the  stomach  juice  can  also  be  produced  by 
the  sense  of  taste.  Professor  Bickel  showed  this  in  the  above 
case  by  placing  on  the  girl's  tongue  a  solution  of  sugar,  and  again 
of  salt,  and  there  followed  each  time  a  secretion  of  stomach  juice. 

Pawlow  has  also  proved  this  by  ingenious  experiments  on 
dogs.  After  making  a  fistula  in  their  oesophagus  he  gave  them 
pieces  of  meat  to  eat,  which,  on  being  swallowed,  fell  out  again 
by  the  open  oesophagus,  so  that  they  never  reached  the  stomach ; 
and  yet  the  taste  of  the  meat  and  chewing  were  sufficient  to  cause 
the  production  of  a  large  amount  of  gastric  juice. 

Thus  the  secretion  of  the  gastric  juice  is  under  nervous 
influence.  But  if  pleasant  nervous  impulses  are  able  to  promote 
its  secretion,  on  the  other  hand,  as  shown  by  the  observations  of 
Beaumont,  and  also  of  Sommerfeld  on  men,  disagreeable  impres- 
sions are  able  to  check  it.  Bickel  and  Sasaki  have  also  observed 
this  to  have  occurred  in  persons  who  have  been  in  a  state  of  anger, 
which  coincides  with  our  own  observations  that  when  we  are  in 
a  depressed  mental  condition,  or  when  we  receive  disagreeable 
news,  we  often  lose  our  appetite.  If,  therefore,  we  want  to  eat 
with  relish  we  must  put  aside  all  mental  pre-occupation  and 
worry,  and  go  to  the  table  in  a  cheerful  mood.  Persons  of  a 
melancholy  temperament  seldom  have  an  appetite,  and  in  melan- 
cholia there  is  often  a  refusal  to  eat,  so  that  nourishment  has  to 
be  maintained  artificially. 

When  any  one  has  been  working  in  the  open  air  all  day  and 
is  of  a  cheerful  disposition,  he  will  not  need  anything  appetizing 
to  make  him  eat.  By  his  work  he  has  digested  his  food  easily, 
his  body  craves  for  more  to  keep  up  his  energy,  and  his  empty 
stomach  requires  to  be  filled ;  he  will  be  hungry  and  have  a  good' 
appetite  without  any  artificial  stimulus. 

But  it  is  a  different  thing  with  ladies  who  sit  all  day  long  in 


Hygiene  of  Hating.  341 


their  rooms,  or  with  men  who  sit  all  day  at  their  office  desks. 
Such  persons  very  often  need  an  artificial  stimulus  for  a  good 
appetite  and  sufficient  gastric  juice.  We  must  then  resort  to 
small  artifices  to  induce  these.  A  snow  white  table  cloth,  beauti- 
ful service,  choice  fruit  in  artistic  vases,  wearing  clean  linen  and 
evening  dress,  and  having  agreeable  society  and  possibly  music  at 
dinner,  will,  perhaps,  sufficiently  act  on  the  different  senses  to 
produce  appetite  and  a  free  secretion  of  the  gastric  juice. 

In  certain  restaurants  we  often  see  an  open  buffet  with  the 
choicest  dishes  displayed,  from  which  we  can  select  our  meal; 
and  this  certainly  acts  as  an  appetizer.  In  certain  countries, 
also,  it  is  the  custom  to  take  before  dinner  little  hors  d'ocuvrcs 
or  delicacies,  like  the  Zakuski  in  Russia,  or  the  smorgasbord  in 
Sweden,  which  certainly  serve  to  enhance  the  appetite. 

Those  whose  appetite  needs  stimulation  may  receive  benefit 
from  meat  extracts,  such  as  bouillon,  before  dinner.  These  ex- 
tracts are  some  of  the  few  things  which  can  produce  a  sufficient 
secretion  in  the  stomach  directly,  without  the  intervention  of 
appetite,  as  has  been  shown  by  the  experiments  of  many  authori- 
ties. Such  an  appetizer  would  not,  however,  be  advisable, 
because  bouillon,  containing  extractive  substances,  is  more  inju- 
rious than  meat  if  taken  often  and  in  large  quantities. 

For  such  as  have  no  appetite  it  may  be  of  advantage  to 
wash  the  tongue  before  meals  with  a  solution  of  salt;  this, 
to  a  certain  extent,  will  also  cleanse  a  coated  tongue,  with 
which  a  good  appetite  is  not  easily  attained;  and  at  the  same 
time,  according  to  Bickel's  above-mentioned  experiment,  it  may 
provoke  a  secretion  of  stomach  juice.  Vinegar  and  water  will 
have  the  same  effect  as  the  saline  wash.  A  coated  tongue  should 
always  be  cleansed  before  meals,  for  when  the  papillae  of  taste 
are  covered,  the  direct  action  of  the  food  on  them  may  be 
prevented. 

Just  before  dinner,  and  for  an  hour  after  it,  no  mental  work 
should  be  done ;  and  it  is  often  better  to  open  a  letter  after  than 
before  dinner,  so  as  not  to  spoil  the  appetite.     A  short  walk  in 


342  Old  Age  Deferred. 


the  fresh  air  before  dining  will  also  be  an  appetizer.  We  have 
personally  noticed  a  diminution  in  appetite  on  those  days  when 
no  exercise  was  taken. 

Much  depends  on  the  way  the  meals  are  served.  Above  all 
things  food  must  be  pleasant  to  the  eye  and  to  the  palate,  and 
it  is  the  great  art  of  the  cook  to  fulfill  this.  The  greatest  pos- 
sible cleanliness  is  paramount,  for  with  many  people  the  sight  of  a 
dirty  cloth  or  napkin  is  able  to  kill  all  appetite  and  check  the 
secretion  of  gastric  juice. 

Reading  while  eating  is  contrary  to  the  above  indications, 
unless  perhaps  it  be  something  humorous,  like  Mark  Twain's 
"Adventures  of  Huckleberry  Finn,"  for  instance.  If  we  have  the 
chance  of  choosing  our  neighbors  at  the  dinner  table  let  us  rather 
sit  next  some  one  having  the  characteristics  of  Mark  Twain  than 
an  undertaker  or  one  who  talks  business. 

Besides  the  gastric  juice  the  saliva  also  plays  a  very  im- 
portant role,  as  it  contains  a  valuable  ferment  which  facilitates 
the  digestion  of  starch  into  sugar :  the  diastatic  ferment.  In  or- 
der to  have  a  good  supply  of  saliva  the  food,  must  be  kept  longer 
on  the  tongue,  as  the  flow  of  saliva  is  best  induced  by  the  stimula- 
tion of  the  nerves  of  taste ;  so  we  must  masticate  longer,  and  move 
the  food  between  the  teeth  and  on  the  tongue  for  as  long  a  time 
as  possible,  so  that  it  will  act  on  the  nerves  of  taste. 

The  secretion  of  the  salivary  glands  under  nervous  influence 
is  actuated  in  the  same  way  as  is  that  of  the  gastric  juice.  It  is 
powerfully  influenced  by  psychical  inpressions;  for  instance,  by 
impulses  coming  from  sight  to  the  nervous  centers  and  thence  to 
the  salivary  glands,  as  can  easily  be  seen  by  daily  observation. 
If  we  offer  a  hungry  dog  a  sausage  we  shall  all  witness  an  abun- 
dant flow  of  saliva,  and  the  same  may  also  be  seen  in  man,  and  the 
German  saying,  "das  wasser  lauft  im  Munde  zusammen," 
may  be  literally  true. 

The  secretion  of  saliva  can  be  provoked  by  much  the  same 
agencies  as  that  of  the  stomach  juice,  but  above  all  by  mastica- 
tion.    This  has  the  greatest  effect  on  the  flow  of  saliva,  espe- 


Hygiene  of  Eating.  343 


cially  when  accompanied  by  good  appetite ;  in  fact,  we  may  say 
good  appetite  provokes  the  flow  of  saliva  and  mastication  main- 
tains it  for  a  long  time.  We  are  thus  able,  by  abundant  saliva- 
tion, to  aid  digestion  wonderfully,  especially  with  regard  to 
starchy  food,  as  the  diastatic  ferment  of  the  saliva  assists  in  trans- 
forming starch  into  sugar ;  otherwise  such  material  would  be 
rather  difficult  to  digest,  only  depending  then  on  the  pancreatic 
and,  perhaps,  intestinal  ferments.  Another  great  advantage  of 
thorough  mastication  is  that  the  food  reaches  the  stomach  in  the 
smallest  possible  pieces,  perhaps  in  liquid  form,  and  thus  the 
stomach  juice  can  reach  it  freely  from  all  sides,  whereby  digestion 
is  greatly  facilitated. 

Not  only  the  digestion  in  the  stomach,  but  also  the  absorp- 
tion of  food  transformed  into  a  liquid  from  the  intestines  is 
much  assisted  by  thorough  mastication;  while,  as  the  result  of 
insufficient  mastication,  as  with  fast  eaters,  the  food  may  cause 
much  greater  work  to  the  walls  of  the  stomach.  Being  much 
less  absorbed  from  the  intestine  it  may  irritate  it  as  a  foreign 
body  until  expelled  by  greater  efforts  of  the  intestinal  walls. 
Long-lasting  gastric  and  intestinal  catarrhs  may  result  from 
insufficient  mastication. 

The  great  advantage  of  methodical  long  mastication  has 
been  shown  by  Harry  Campbell,2  Horace  Fletcher,3  and  Van 
Sommeren,  of  Venice.  According  to  their  recommendation  it 
would  be  necessary  to  masticate  food  until  it  has  almost  lost  its 
taste.  It  certainly  requires  long  practice,  especially  in  the  case 
of  fast  eaters,  to  acquire  the  habit  of  prolonged  mastication,  for 
nothing  is  so  difficult  as  to  give  up  habits  indulged  in  since 
childhood.  Fast  eating  is  not  only  injurious  to  health,  but  if 
indulged  in  in  company,  it  is  a  breach  of  good  manners. 

The  authorities  on  thorough  mastication  also  claim  that  by 
so  doing  they  are  able  to  do  with  less  food,  which  is  the  more 
readily  to  be  believed,  as  they  are  able  to  digest  and  absorb  every- 


2  "Observation  on  Mastication,"  Lancet,  vol.  ii,  1903. 

3  Horace  Fletcher:     "The  A,  B-Z  of  Nutrition,"  New  York,  1904. 


344  Old  Age  Deferred. 


thing  better,  their  food  leaves  less  residue,  and  they  profit  more 
by  what  they  eat  than  do  fast  eaters  and  bad  masticators. 

Good  mastication  means  also  good  exercise  for  the  teeth,  the 
good  condition  of  which  is  of  the  utmost  importance  for  a 
healthy  digestion  just  as  it  is  important  for  all  other  organs  of 
the  body.  When  we  eat  fast  we  are  inclined  to  wash  down  the 
imperfectly  masticated  food  by  large  quantities  of  water,  which 
may  be  prejudicial,  as  we  are  thus  too  freely  diluting  the  contents 
of  the  stomach.  Many  women  abstain  from  drinking  at  their 
meals  for  fear  of  getting  fat,  which  is  an  erroneous  idea,  as 
Prof.  Van  Noorden  has  shown  that  this  cannot  produce  obesity.4 
On  the  other  hand,  not  drinking  during  meals  may  lead  to  bad 
results.  We  are  accustomed  to  take  most  of  the  water  we  drink 
with  our  meals;  not  taking  any  at  meals  may  largely  decrease 
the  amount  of  fluid  in  the  body,  which  has  many  bad  effects.  As 
shown  by  Pawlow,  and  also  by  Bickel,  more  stomach  juice  is 
secreted  when  the  body  contains  more  fluid.  Then  drinking  a 
certain  amount  of  water  at  meals  may  assist  in  the  absorption  of 
the  food.  There  is  also  the  great  advantage  that  by  the  aid  of 
fluids  the  end-products  of  nitrogenous  matters,  which  have  toxic 
actions,  may  be  more  easily  eliminated  from  the  body  than  with  a 
dry  diet.  We  believe  it  is  preferable  to  take  even  an  excess 
of  water,  than  none  at  all,  with  meals,  and  there  are  many  people 
who  have  no  appetite  unless  they  drink  while  eating. 

The  question  whether  after  meals  we  should  rest  or  take 
exercise  must  be  answered  individually;  those  suffering  from 
obesity  or  other  disorders  of  metabolism,  like  gout  or  diabetes, 
had  better  take  some  form  of  exercise  after  a  meal,  while  weak 
persons  should  rest.  In  general,  a  short  walk  after  meals,  and 
then  remaining  quiet  for  an  hour,  will  prove  to  be  best;  but 
mental  occupation  for  at  least  an  hour  after  meals  should  be 
strictly  prohibited. 

The  time  for  meals  should  be  when  we  are  hungry,  as  we 
should  never  eat  at  other  times  for  fear  of  not  being  able  to  digest 
4  v.  Noorden:     "Die  Fettsucht,"  Nothnagel's  Handbuch. 


Hygiene  of  Eating.  345 


well,  owing  to  the  absence  of  stomach  juice.  It  is  essential  to 
take  our  meals  every  day  at  the  same  time ;  our  stomach  is  of  such 
a  clock-like  mechanism  that  it  best  indicates  the  hour  for  meals. 
If  well  disciplined  it  will  secrete  its  gastric  juice  every  day  at 
the  same  hour.  If  possible  we  should  always  eat  in  company, 
for  then  we  will  eat  slower,  masticate  better,  and,  if  the  company 
is  jovial,  probably  secrete  more  gastric  juice. 

Just  as  after  meals,  so  also  before  them,  any  strenuous  exer- 
cise should  be  forbidden.  A  little  exercise  may  promote  the 
gastric  digestive  secretions;  but  if  we  become  tired  from  much 
exercise,  then  certainly  not  much  and  sometimes  no  gastric  juice 
will  be  secreted ;  then  meat  extracts,  bouillon,  or  soup  will  be 
necessary  for  obtaining  an  appetite.  Some  people  eat  too  much 
bread,  which  may  cause  overwork  for  the  stomach,  as  to  digest 
bread  gives  it  more  work  than  does  other  food.  It  has  been 
found  that  the  albuminous  parts  of  bread  require  five  times  more 
ferments  and  pepsin  of  the  stomach  than  does  meat ;  besides 
which,  as  we  have  found  in  many  of  our  patients,  there  is  nothing 
that  causes  an  acid  stomach  so  often  as  does  too  much  bread, 
especially  in  nervous  people. 

The  most  digestible  food  for  most  stomachs  is  meat,  if  it 
does  not  contain  much  connective  tissue.  Meat  sauces  and 
bouillon  are  excellent  appetizers.  However,  such  nourishment 
at  every  meal  has  its  inconveniences,  on  which  we  will  enlarge 
in  another  chapter.  It  is  most  desirable  only  to  take  meat  once 
a  day — at  dinner. 

The  albumin  in  meat  is  much  easier  to  digest  than  that  in 
vegetables;  to  digest  the  latter,  particularly  potatoes,  cabbage, 
etc.,  we  need  to  have  a  thoroughly  good  stomach.  Fat  dishes  are 
able  to  diminish  the  quantity  of  stomach  juice,  and  fatty  pota- 
toes or  other  vegetables  with  much  fat,  demand  sound  stomachs, 
in  the  same  way  as  does  rich  pastry.  Butter  is  an  easily  digested 
fat  if  it  is  fresh,  but  certainly  not  when  it  contains  free  fatty  acids. 

Besides  meat,  cereals,  such  as  are  taken  in  America  at  break- 
fast, especially  when  finely  ground  and  taken  in  the  form  of 


346  Old  Age  Deferred. 


flour,  are  most  easily  digested.  It  is  an  excellent  American  cus- 
tom to  commence  breakfast  with  grape-fruit,  which  is  somewhat 
astringent  and  very  refreshing;  but  to  begin  breakfast  with  an 
apple  or  a  pear  is  the  greatest  possible  offense  to  a  normal  stom- 
ach, and  occurs  only  because  of  the  lack  of  a  thorough  knowledge 
of  the  physiology  of  the  stomach. 


CHAPTER   XLII. 

On  the  Uses  of  Small  Doses,  and  the  Deleterious  Action 
of  Large  Quantities  of  Alcohol. 

In  everyday  life  we  are  exposed  to  worry  and  disappoint- 
ment; and  also,  as  many  of  us  easily  tire  after  work,  we  fre- 
quently feel  an  inclination  to  take  something  to  cheer  us  up  and 
to  incite  us  to  further  exertions ;  thus  we  take  stimulants,  such  as 
alcohol,  tea,  coffee,  tobacco,  etc. 

We  may  fairly  compare  these  stimulants  to  a  whip  with 
which  we  urge  on  a  horse.  A  short  reflection,  however,  will 
teach  us  that  rest  would  be  the  best  stimulant  for  a  tired  horse; 
but,  unfortunately,  physiological  thinking  is  not  yet  the  common- 
sense  view  of  all. 

A  willing  horse  requires  no  whip,  and  many  of  us  are  able 
to  attain  a  good  old  age  without  requiring  any  stimulants.  The 
grandfather  of  the  author  of  this  work  has  attained  the  age  of 
105  without  taking  any  stimulants. 

As  our  numerous  friends,  both  in  America  and  England, 
know,  we  do  not  take  any  alcohol,  not  from  principle,  but  because 
we  find  no  pleasure  in  so  doing.  Still  we  don't  feel  inclined  to 
follow  the  anti-alcohol  fanatics  in  their  crusade,  because  we  de- 
test fanaticism  of  any  kind,  whether  displayed  by  Chinese,  by 
Mohammedans  in  Bochara  or  Morocco,  or  by  Christians  in  Eng- 
land or  America.  We  also  do  not  uphold  such  narrow-minded- 
ness as  prohibiting  even  the  smallest  amount  of  alcohol  to  those 
who  only  take  it  in  the  greatest  mockration,  solely  on  the  ground 
that  there  are  some  good-for-nothings  who  can  never  take  it 
without  getting  drunk.  With  equal  justice  might  we  take  away 
the  fortune  from  a  man  who  has  gained  it  by  his  labor,  on  the 
ground  that  there  are  others  starving  because  they  will  not  work. 
We  are  not  prepared,  either,  to  accept  the  dictum  of  the  anti- 

347) 


348  Old  Age  Deferred. 


alcoholics  that  alcohol  is  a  poison  even  in  small  quantities.  We 
do  not  deny  that  there  are  many  among  them  who  cannot  stand 
even  small  quantities,  which  is  a  probable  reason  why  they  are 
so  clamorous  against  it;  but  they  do  not  possess  normal  health, 
physically  or  mentally;  and  the  supposition  is  not  unjustified  that 
there  is  in  some  of  them  a  lessened  tolerance  for  alcohol  owing 
to  their  previous  immoderate  libations. 

The  truth  is,  as  shown  by  many  physiologists,  such  as 
Atwater  and  Benedict,  and  also  by  Professor  Tigersted,1  even 
at  the  Anti-Alcoholic  Congress  at  Stockholm,  that  alcohol  may 
be  regarded,  but  in  small  doses  only,  as  a  precious  gift,  for  by  it 
we  may  preserve  important  parts  of  the  bodily  tissues — carbohy- 
drate and  fatty  substances,  which  may  be  economized  by  the  use 
of  certain  quantities  of  alcohol.  The  nourishing  effect  can  be 
attained  only  if  not  too  much  be  taken,  for  in  over-abundance  a 
decomposition  of  albuminous  substances  can  be  produced  as  a 
toxic  effect. 

Alcohol  in  small  doses  is  unquestionably  an  excellent  stimu- 
lant for  the  nervous  system  and  the  circulatory  apparatus.  There 
are  many  people  who  are  able  to  do  more  work,  especially  of  a 
physical  nature,  when  they  take  a  certain  amount  of  alcohol ;  and 
at  the  same  time  they  have  a  better  appetite  for  food.  Alcohol, 
however,  is  of  more  benefit  in  this  respect  if  we  take  wine;  and 
of  all  alcoholic  drinks,  except  beer,  wine  contains  the  least  per- 
centage of  alcohol,  especially  French  wines,  which  normally  con- 
tain only  9  per  cent.  But  this  stimulating  effect  only  holds  good 
when  we  do  not  take  large  amounts,  for  in  the  latter  case  the 
quality  of  work  is  impaired,  especially  mental  labor. 

In  a  given  quantity,  and  preferably  in  the  shape  of  red 
wine,  alcohol  is  able  to  cheer  us  up,  and  to  a  certain  extent 
diminish  grief  and  sorrow ;  but  after  taking  large  quantities  we 
feel  more  depressed. 

Beer  is  more  nourishing  than  wine,  but  has  a  more  sluggish 
effect.     English  and  some  kinds  of  American  beer  often  contain 


1  Quoted  after  Dr.  Hollitscher,  Prager  med.   Wochenschrift,   1907. 


Deleterious  Action  of  Alcohol.  349 

nearly  as  much  alcohol  as  some  kinds  of  wine,  sometimes  more 
than  light  Tyrolean  or  Italian  wines. 

The  most  beneficial  form  of  alcohol  is  a  light  wine,  and,  as 
a  medical  stimulant,  the  older  vintages  of  French  wines.  Beer 
may,  to  some  extent,  assist  digestion,  owing  to  its  bitter  con- 
stituents. It  is  true  that  it  contains  the  least  percentage  of  alco- 
hol of  all  beverages  of  this  nature,  but  it  has  the  disadvantage 
that  it  is  taken  in  larger  quantities  as  one  gets  accustomed  to  it, 
and  thus  more  alcohol  and  a  larger  amount  of  liquid  may  be 
introduced,  the  result  of  which  may  be  injurious  to  the  circula- 
tory system  (see  "Hygiene  of  the  Food"). 

Observation  proves  that  many  old  people  thrive  well  on 
a  small  amount  of  claret  or  other  red  wine  taken  daily  at  meal 
times.  In  such  cases  it  may  be  regarded  as  a  harmless  tonic,  if 
taken  only  in  small  quantities,  and  if  their  health  be  otherwise 
normal  except  for  the  debility  attributable  to  old  age.  Dr.  Savile, 
of  London,  has  also'  found  salutary  effects  from  moderate  and 
exactly  regulated  quantities  of  alcohol  in  the  aged  inmates  of  the 
workhouse  infirmary. 

In  our  judgment  we  shall  be  best  guided  by  the  way  in  which 
our  regular  patients  tolerate  alcohol.  When,  having  been  accus- 
tomed to  it  all  their  life,  they  ask  for  wine  or  whiskey,  and  they 
can  tolerate  it  well,  we  admit  that  small  amounts  act  as  a  kind 
of  tonic  for  them ;  but  it  should  never  be  given  if  there  is  an  in- 
compatibility for  it,  for  then  it  is  distinctly  harmful  and  should 
be  avoided. 

Brandy  is  the  most  dangerous  form  of  alcohol,18,  but  whiskey 
in  small  doses  may  be  reckoned  much  less  harmful;  but  the 
least  injurious  of  all  are  light  wines  and  the  still  lighter  kinds 
of  beer,  which  contain  only  some  3  per  cent,  of  alcohol. 

That  wine  may  be  taken  without  harm,  even  to  considerable 
old  age,  can  be  illustrated  by  a  series  of  examples,  of  which  we 


X*  There  may  be  exceptions,  however.  The  father-in-law  of  a  Swedish 
lady  patient  of  ours  is  at  present  96*4  years  old.  For  a  good  many  years  the 
old  gentleman  has  been  drinking  daily  a  large  amount  of  cognac. 


350  Old  Age  Deferred. 


have  mentioned  some  already,  where  persons  have  reached  ioo 
years  of  age  in  spite  of  drinking  wine  every  day.  They  might, 
perhaps,  have  lived  longer  had  they  taken  no  alcohol,  for,  as  a 
rule,  such  persons  come  from  long-lived  families,  and,  as  we  have 
said  previously,  such  people  may  permit  for  themselves  greater 
license  in  this  respect ;  but  this  must  be  distinctly  regarded  as  the 
exception,  for,  as  the  statistics  of  the  United  Temperance  Asso- 
ciation in  England  show,  total  abstainers  have  a  much  greater 
chance  for  a  long  life  than  have  others.  According  to  Neisson's 
investigation  of  6111  persons  from  16  to  90  years  of  age  who 
were  taking  alcohol,  the  ratio  of  mortality  among  them  was 
three  times  greater  than  for  the  whole  population  of  England. 

Sir  Isambard  Owen  shows,  by  a  careful  analysis  of  the 
results  of  the  Collective  Investigation  Returns,  comprising  4287 
persons,  that  the  average  duration  of  life  is  greatest  among 
total  abstainers  and  very  moderate  drinkers,  and  that  but  few 
addicted  to  much  alcohol  were  among  the  long  lived ;  those  in 
the  latter  condition  can  only  expect  a  shortening  of  life,  which 
proves  conclusively  that  alcohol  is  very  deleterious  to  the 
organism. 

As  post-mortem  examinations  show,  all  the  organs  of  the 
body  suffer  degeneration  after  coming  in  contact  with  large 
quantities  of  alcohol.  It  would  be  impossible  to  dilate  here 
upon  all  these  different  changes.  We  will,  therefore,  only  men- 
tion the  effects  of  alcohol  on  the  most  important  organs — for 
example,  the  heart  and  blood-vessels. 

As  is  well  known,  alcohol,  if  taken  in  large  quantities,  degen- 
erates the  heart  muscles  and  also  produces  the  condition  of 
arteriosclerosis.  Its  effects  on  the  brain  are  particularly  delete- 
rious. If  taken  once  only,  but  in  large  measure,  it  is  sufficient  to 
cause  intoxication,  with  changes  in  the  mental  faculty.  Taken 
habitually,  as  by  chronic  alcoholics,  these  mental  changes  may 
develop  into  a  permanent  character,  and  thus  insanity  may  follow. 
According  to  the  official  statistics  of  the  Kingdom  of  Wurttem- 
burg,  about  60  per  cent,  of  the  inmates  of  lunatic  asylums  were 


Deleterious  Action  of  Alcohol.  351 

alcoholics.  Out  of  579  lunatics  of  the  Provincial  Insane  Asy- 
lum, in  Vienna,  in  1899,  there  were  40  per  cent,  alcoholics. 

As  we  have  shown  in  our  address  at  a  special  meeting 
of  the  Philadelphia  Medical  Jurisprudence  Society,  insanity  and 
crime  stand  in  very  close  relationship,  and,  in  fact,  crime  may 
be  regarded  as  a  nervous  disease.  We  should,  therefore,  not 
be  surprised  to  find  so  many  criminals  among  alcoholics.  Ac- 
cording to  statistics  prepared  in  Germany,  some  63  per  cent,  of 
cases  of  injury  to  the  person,  69  per  cent,  of  robbery  and  murder, 
and  yy  per  cent,  of  sexual  crimes  were  committed  by  persons 
under  the  influence  of  alcohol ;  and  according  to  Dr.  Scharf- 
fenberg,  of  Christiania,  if  there  were  no  alcoholics  crime  would 
be  diminished  by  one-half. 

A  person  committing  a  crime  while  under  the  influence  of 
alcohol  is  no  more  responsible  than  a  person  who  does  the  same 
thing  while  in  a  state  of  delirium  caused  by  some  infectious  dis- 
ease, or  while  under  the  influence  of  such  a  poison  as  muscarin 
or  atropin,  which  produces  an  intoxication  similar  to  that  of 
alcohol. 

Of  the  other  organs  which  are  injured  by  alcohol  we  must 
put  in  the  front  rank  the  various  ductless  glands,  which  are  of 
special  importance  to  us. 

The  frequency  of  impotency  in  chronic  alcoholism  proves 
how  injurious  to  the  sexual  glands  are  large  quantities  of  alco- 
hol. The  same  applies  to  the  adrenals,  as  shown  by  the  fre- 
quency of  arteriosclerosis  in  alcoholics.  From  one  dose  of 
alcohol  we  can  often  see  an  increase  in  blood-pressure.  It  has 
been  shown  by  Dr.  Sajous  that  alcohol  acts  in  a  very  deleterious 
way  upon  the  pituitary  body  when  taken  in  anything  but  small 
quantities  or  well  diluted  as  in  beer  or  light  wines ;  he  illustrates 
this  fact  in  a  very  instructive  microscopic  specimen.2 

In  the  same  way  the  bad  effects  of  alcohol  on  the  kidneys  and 
liver  are  amply  demonstrated  in  the  handbooks  of  clinical  medi- 
cine and   pathological   anatomy,   with   which   we   are   all   well 

2  Sajous:     "Internal  Secretions,"  vol.  ii,  p.  1332,  1907. 


352  Old  Age  Deferred. 


acquainted ;  and  the  constant  occurrence  of  cirrhosis  of  the  liver 
and  interstitial  nephritis  in  alcoholics  plainly  show  this. 

A  matter  of  grave  importance  to  us  is  also  the  degeneration 
of  the  thyroid  in  alcoholics,  as  found  by  the  researches  of  de 
Quervain3  and  Sarbach3a  and  the  clinical  observations  of 
Hertoghe.4 

These  degenerating  effects  of  alcohol  on  the  ductless  glands 
will  explain  why  premature  old  age  is  so  often  found  in  alco- 
holics, especially  when  brandy  and  liqueurs  are  taken;  but  still 
worse  consequences  than  this  also  arise,  viz. :  the  diminution  of 
the  powers  of  resistance  to  infection  or  intoxication,  in  conse- 
quence of  the  lack  of  those  important  protective  elements  which, 
as  we  see  in  Chapter  III,  are  derived  from  the  ductless  glands,  a 
fact  which  various  epidemics  amply  prove.  My  friend,  Dr.  Mac- 
Means,  told  me  during  a  stay  in  Monterey,  Mexico,  that  in 
an  epidemic  of  yellow  fever,  he  observed  that  alcoholics  were 
among  the  first  to  contract  it. 

We  know  the  great  frequency  of  tuberculosis  in  alcoholics, 
and  the  great  mortality  in  such  persons  from  pneumonia.  They 
are  unable  to  withstand  the  high  fever  and  cannot  combat  the 
infection,  and  the  heart  soon  fails ;  and  also,  as  a  general  rule,  in 
all  cases  of  infectious  diseases  their  chances  are  much  worse 
than  are  those  of  other  people. 

We  note  in  Chapter  VI  that  heredity  depends  on  the  con- 
dition of  the  ductless  glands  of  the  parents.  This  is  also  the  case 
with  alcoholics,  and  it  is  a  fact  that  the  descendants  of  such  are 
heavily  handicapped ;  and,  as  also  mentioned  in  Chapter  VI,  con- 
genital myxcedema  and  scrofulosis  is  prevalent  among  them, 
and  their  chances  for  a  long  youth  discounted.  Nervous  dis- 
eases are  also  of  constant  occurrence  among  these,  such  as  idiocy, 
epilepsy,  etc.,  very  interesting  data  as  to  which  are  given  by 
Legrain.     A   certain   alcoholic   was   eight   times    in   the   insane 


3  de  Quervain:     Semaine  Med.,  1895. 

3aSarbaeh:     Mitth.  Grenzgebiete  Med.  u.  Cliir.,  1906,  p.  213. 

4  Hertoghe :     hoc.  cit. 


Deleterious  Action  of  Alcohol.  353 

asylum  for  delirium  tremens.  He  had  nine  children;  three  died 
at  birth  from  general  debility,  one  died  of  convulsions  within  the 
first  year,  and  the  other  five  suffered  from  trembling  in  the 
extremities.  The  father  of  this  person  was  also  a  drunkard, 
who  hanged  himself;  the  mother,  a  brother,  and  a  sister  were 
also  dipsomaniacs. 

Martin  found  in  60  out  of  83  female  epileptics,  alcoholism 
in  the  parents.  Demme  examined  57  children  among  such,  and 
found  only  10  who  were  normal,  physically  and  mentally. 

A  terrible  genealogy  is  that  traced  by  Dr.  Klausner  con- 
cerning a  woman  named  Ada  Take,  born  in  1740,  who  was  a 
dipsomaniac.  She  had  709  descendants,  among  whom  were 
100  illegitimate  children,  181  prostitutes,  142  beggars,  46  work- 
house inmates,  76  criminals,  and  the  remainder  were  more  or 
less  habitual  drunkards.  This  one  family  cost  the  country  or 
prison  authorities  for  their  support  over  three  million  florins 
($1,200,000). 

In  tropical  climates  the  effects  of  alcohol  are  most  perni- 
cious. According  to  Dr.  Hueppe,  it  is  the  greatest  enemy  to 
the  European.  From  the  official  report  of  the  British  Commis- 
sioner General  for  Central  Africa,  in  1894,  "the  use  of  beer,  wine, 
and  spirits  is  more  destructive  to  our  tropical  colonies  than  all  the 
bacilli  and  plasmodia;"  and  according  to  the  great  African  ex- 
plorer, Emin  Pasha,  the  tropics  offer  no  dangers  to  the  health 
of  such  as  can  abstain  from  large  amounts  of  stimulants.  It  is 
very  likely  that  what  atrocities  have  been  credited  to  Europeans 
in  Africa  were  due  to  alcohol. 

From  the  foregoing  facts  it  is  clear  that  large  quantities 
of  alcohol  are  most  injurious,  but  there  is  no  scientific  evidence 
to  prove,  with  exactitude,  that  small  doses  are  harmful. 

Some  experiments  in  this  direction  have  been  made  by 
Laitinen,5  but  they  were  performed  on  rabbits  and  guinea  pigs, 
to  which  he  gave  very  small  doses  (only  0.1  centimeter  per  kilo 
body-weight).     He    found    that    the    hemolytic    ability   of   the 

5  International  Congress  of  Anti- Alcoholics,  Stockholm,  1902. 

23 


354  Old  Age  Deferred. 


blood  was  impaired,  and  that  there  was  a  greater  mortality 
among  their  young  than  among  the  young  of  those  kept  on  water. 
Laitinen,  himself,  did  not  dare  to  draw  conclusions  from  these 
experiments ;  nor  can  we,  for  there  is  a  great  difference  between  a 
man  and  a  rabbit.  But  if  an  inference  may  be  deduced  from  such, 
we  can  apply  it  to  children,  for,  as  is  well  known,  the  effects  of 
drugs  on  small  animals  offer  better  comparisons  for  children  than 
for  adults.  For  this  purpose,  however,  we  need  not  refer  to  the 
experiments  of  Laitinen,  for  Dr.  Maurice  Kende  has  lately  ex- 
perimented on  20  children  between  6  and  15  years  of  age,  who, 
after  very  small  quantities  of  wine,  exhibited  an  impairment  of 
their  mental  faculties. 

Dr.  Hercod  has  also'  shown  that  out  of  591  Viennese  school 
children,  the  best  certificates  for  scholarship  were  gained  by 
those  who  took  no  alcoholic  drinks;  instructional  results  were 
not  quite  so  satisfactory  in  those  who  occasionally  did  so ;  but  the 
worst  scholars  of  all  were  those  who  took  alcohol  two  or  three 
times  a  day.  According  to  Viennese  life,  beer  is  generally  meant 
by  the  term  "alcohol,"  and,  in  a  much  less  degree,  wine. 

That  children  are  susceptible  to  alcohol,  as  to  all  poisons 
in  general,  has  been  already  mentioned  in  Chapter  X ;  so  it  is 
not  surprising  if  only  small  quantities  should  unfavorably 
affect  their  mental  faculties.  We  have  also  previously  insisted 
upon  the  necessity  of  considering  it  a  crime,  meriting  a  heavy 
punishment,  to  give  alcohol  to  children.  But  we  again  repeat 
that  there  is  not  sufficient  strictly  scientific  evidence,  as  yet,  to 
prove  that  small  quantities  of  alcohol  (especially  beer  or  wine, 
and  possibly  whiskey)  are  deleterious  to  the  majority  of  adults; 
those  who  cannot  stand  even  small  quantities  will  be  best  without 
any ;  but  we  fail  to  see  why  a  working  man,  when  he  comes  from 
his  daily  labor,  should  be  forbidden  to  take  his  glass  of  beer.  It 
is  certainly  not  the  temperate  users  of  stimulants,  the  hard 
workers,  that  should  be  persecuted  by  anti-alcoholics,  but  the 
intemperate  users,  who  are  a  real  curse  to  humanity.  If  those 
fanatics  will  limit  their  action  in  this  useful  direction  only,  every 


Deleterious  Action  of  Alcohol.  355 


physician  will  be  only  too  anxious  to  support  them;  but  instead 
of  this,  like  Don  Quixote  against  the  windmills,  they  forbid  the 
use  of  alcohol  entirely  to  persons  who  simply  cannot  exist  with- 
out it;  in  fact,  they  might  just  as  reasonably  forbid  them  to  eat, 
drink,  or  sleep ! 

We  firmly  believe  that  the  best  course  is  to  discover  the 
cause  which  compels  such  people  to  drink  so  much  that  they  can- 
not discontinue  the  habit,  and  by  finding  the  cause  we  shall 
ascertain  the  origin  of  the  disease  and  can  then  treat  it  rationally, 
as  we  will  endeavor  to  show  in  the  succeeding  chapter.  Physi- 
cians, and  not  clergymen,  are  best  qualified  to  fight  the  alcoholic 
habit,  just  as  they  are  best  qualified  to  fight  all  other  diseases. 
That  alcohol  in  small  quantities  cannot  be  such  a  poison  as 
claimed  by  these  faddists,  is  also  shown  by  the  great  number  of 
moderate  drinkers  who  live  to  be  much  above  ioo  years  old.  At 
the  present  time  there  are  also  within  our  knowledge  several 
persons  over  ioo  years  old  who  take  every  day  a  certain  amount 
of  alcohol.  Thus  an  old  general  in  Berlin,  who  reached  his  103d 
birthday  last  December,  is  accustomed  to  go,  every  day,  to  a  beer 
house  to  have  his  glass  of  beer.  Mrs.  Andie  Campbell,  of  Spring- 
burn,  near  Glasgow,  who  attained  her  103d  birthday  in  January, 
1908,  attributes,  as  the  newspapers  stated,  her  old  age  to  the 
moderate  use  of  whiskey,  which  she  has  been  accustomed  to  drink 
all  her  life.  According  to  the  report  of  the  Collective  Investiga- 
tion Committee  of  the  British  Medical  Association,  most  of  the 
51  centenarians,  whose  cases  were  investigated,  were  total 
abstainers,  but  5  were  very  fond  of  alcohol.  One  of  them,  Peggy 
Walsh,  who  is  said  to  have  attained  127  years,  was  in  the  habit 
of  taking  daily  before  dinner  an  ounce  of  whiskey  in  water.6 
Thus  it  seems  conclusive  that  the  use  of  moderate  quantities  of 
alcohol  does  not  seriously  impair  our  chances  for  living  to  a  good 
old  age. 

6  Quoted  after  Humphrey,  "Old  Age,"  Cambridge,  1889. 


CHAPTER   XLIII. 

Some  Remarks  on  the  Causes  and  Prevention  of  the 
Alcohol  Habit. 

It  is  a  strange  fact,  but  one  in  which  all  observers  agree, 
that  women  who  have  never  been  accustomed  to  take  alcohol, 
can  stand  considerable,  and  sometimes  very  large,  quantities  of 
it  during  convalescence  after  infectious  diseases,  such  as  pneu- 
monia, etc.  It  is  equally  strange  that  in  severe  cases  of 
diabetes,  where  previously  opium  had  never  been  taken,  very 
large  doses  of  this  drug  may  be  used  without  any  inconvenience. 
We  have  also  observed  that  women  suffering  from  severe  dia- 
betes, though  unaccustomed  to  alcohol,  could  take  large  quantities 
of  it — for  instance,  one  or  two  tablespoonfuls  of  whiskey  three 
times  a  day — without  displaying  any  symptom  of  mental  excita- 
tion or  other  signs  of  having  taken  liquor  in  a  quantity  which 
might  provoke  a  state  of  excitation  in  persons  not  used  to  alcohol ; 
in  fact,  the  alcohol  has  been  well  tolerated  and  taken  with 
pleasure. 

In  both  these  conditions — diabetes  (Lorand)  and  infectious 
diseases — the  thyroid  gland  plays  an  etiological  role,  as  we 
have  frequently  indicated  in  this  work.  It  is,  therefore,  justifiable 
now  to  discuss  the  point  whether  the  thyroid  has  something  to 
do  with  the  apparent  paradox  that  alcohol  can  be  taken,  without 
the  display  of  any  signs  of  intoxication,  by  women  who  are  other- 
wise never  in  the  habit  of  taking  spirits. 

That  this  is  really  so  cannot  be  denied,  a  priori,  for  the 
reason  that  between  the  activity  of  the  thyroid  and  the  influence 
of  alcohol  a  certain  relationship  exists.  This  is  evidenced  from 
the  observation,  mentioned  previously,  that  alcohol  acts  upon  the 
thyroid  gland,  at  first  causing  hyperactivity,  and  later  on  ex- 
(356) 


Prevention  of  the  Alcohol  Habit.  357 

haustion  of  it.  As  we  have  already  mentioned,  there  is  a  certain 
analogy  between  the  action  of  chloroform  and  that  of  alcohol  on 
the  thyroid  gland.  In  fact,  we  think  that  it  is  permissible  to 
assume  that  drunkenness  is  a  consequence  of  the  hyperactivity  of 
the  thyroid,  for  in  such  a  condition  there  are  observable  a  series 
of  symptoms  of  thyroid  hyperactivity;  and  it  has  been  shown  by 
Moebius1  that  in  women  suffering  from  Graves's  disease  (hyper- 
activity of  the  thyroid)  we  may  find  a  condition  of  intoxication 
similar  to  that  seen  in  alcoholic  intoxication,  although  such 
women  had  not  taken  even  a  drop  of  alcohol.  This  condition  is 
provoked  by  the  over-abundance  of  thyroid  secretion  in  the  blood. 
In  other  words,  women  suffering  from  this  disease  can  be  drunk 
without  having  taken  any  alcohol  at  all,  simply  because  of  the 
entering  into  their  blood  of  the  secretion  of  the  thyroid  in  large, 
i.e.,  in  toxic,  quantity,  this  having  produced  such  a  condition. 

According  to  several  authors,  whom  we  have  already  quoted 
(de  Quervain,2  Hertoghe3),  alcohol  has  a  great  influence  on  the 
thyroid,  and  in  chronic  alcoholism  the  thyroid  is  found  to  be  de- 
generated. 

If  it  can  be  admitted  that  drunkenness  is  caused  by  the  toxic 
products  of  the  thyroid,  due  to  the  alcohol  acting  on  the  thyroid 
and  causing  its  hypersecretion,  we  can  also  explain  the  mystery 
why  persons  bitten  by  poisonous  snakes  can  also,  in  the  same 
way,  take  very  large  quantities  of  alcohol  without  showing  its 
effects,  even  when  they  have  previously  been  quite  unaccustomed 
to  it.  Snake  poison,  as  do  all  poisons,  creates  a  hyperactivity  of 
the  thyroid  which  results  in  the  throwing  off  of  a  large  amount 
of  colloid  substance.  Exhaustion  follows  this  hyperactivity,  and 
in  this  condition,  as  in  convalescence  from  infectious  diseases,  and 
in  severe  diabetes,  where  there  is  also  a  similar  exhaustion  of  the 
thyroid  after  a  previous  hyperactivity,  a  large  quantity  of  alcohol 
can  be  taken,  merely  because  of  the  fact  that  when  the  thyroid  is 


1  "Die  Basedow'sche  Krankheit,"  Nothnagel's  Handbuch,  second  edition. 

2  Semaine  Medicale,  1905. 

3  Loc.  cit. 


358  Old  Age  Deferred. 


devoid  of  its  colloid,  a  condition  of  hyperactivity,  which  is  the 
cause  of  drunkenness,  cannot  easily  be  provoked,  unless  enormous 
doses  are  given.  We  must,  therefore,  in  cases  of  snake  poison- 
ing give  greatly  increased  doses  of  alcohol  in  order  to  again 
provoke  an  increased  activity  of  the  thyroid,  and  thus  cause  the 
eventual  destruction  of  the  harmful  toxalbumins  of  the  snake 
poison. 

If  women,  in  a  state  of  convalescence  after  pneumonia,  or 
with  severe  diabetes,  and  unaccustomed  to  taking  spirits,  can 
stand  large  quantities  of  alcohol  without  exhibiting  any  signs  of 
excitation,  it  is  very  probably  due  to  the  circumstance  that  the 
thyroid  has  already  thrown  off  its  available  amount  of  colloid, 
is  exhausted,  and  the  doses  given  are  not  yet  sufficient  to  produce 
a  fresh  secretion,  and  thus  the  symptoms  of  drunkenness  do  not 
develop. 

The  result  of  these  observations  is  that  a  degenerated  thy- 
roid cannot  easily  provoke  a  condition  of  drunkenness,  which 
may  also  explain  the  curious  coincidence  that  frequently  chronic 
alcoholics,  even  after  large  quantities  of  alcohol,  do  not  present 
typical  symptoms  of  drunkenness;  in  fact,  sometimes  so  few  of 
such  signs  are  visible  that,  if  a  crime  is  committed  under  such 
influences,  it  is  difficult  to  prove  they  were  really  intoxicated  at 
the  time,  as  they  present  no  visible  signs  of  such  a  condition. 

From  the  foregoing  we  shall,  therefore,  not  be  surprised  to 
find  that  persons  suffering  from  hypothyroidia  or  myxoedema 
can  take  large  quantities  of  alcohol,  and  at  the  same  time  evince 
a  great  liking  for  the  same ;  in  fact,  at  times,  they  have  a  regular 
craving  for  it.  Several  things  will  explain  why  myxedematous 
people  like  to  take  alcohol.  They  invariably  feel  cold,  as  the 
thyroid  regulates  the  temperature  of  the  body;  they  thus  desire 
to  obtain  warmth  from  the  spirit  (which  may  excite  the  function, 
in  a  small  degree,  of  such  parts  of  the  thyroid  as  are  not  yet 
degenerated),  and  thus  produce  symptoms  of  thyroid  hyper- 
activity, by  which  warmth  may  be  produced,  though  they  do 
not  realize  that  subsequently  they  will  be  all  the  colder.     Such 


Prevention  of  the  Alcohol  Habit.  359 

people  arc  also  generally  of  a  dull  apathetic  disposition,  never 
cheerful,  but  in  a  depressed  mood,  owing  to  the  degenerated 
condition  of  the  thyroid ;  and  being  thus  despondent  they  are 
easily  dejected  by  worries  or  disappointment.  That  such  people 
should  resort  to  drink  is  but  natural,  if  we  consider  that  they  can 
take  alcohol  without  visible  effects.  We  must  not  forget  that 
there  are  many  degrees  of  hypothyroidia,  from  light  cases  with  a 
simple  insufficiency  of  the  thyroid  up  to  graver  forms  nearly 
approaching  myxcedema ;  and  all  we  have  said  on  the  above  sub- 
ject will  apply  in  varying  degrees  to  them. 

From  this  we  shall  now  also  understand  why  aged  people 
can  sometimes  take  much  alcohol  without  exhibiting  signs  of 
drunkenness,  which  is  probably  the  origin  of  the  erroneous  idea 
that  "wine  is  the  milk  of  the  aged."  This  can  have  very  baneful 
results,  for  if  small  doses  can  undoubtedly  produce — especially 
when  light  French  wines  are  taken — a  tonic  and  stimulating 
effect  on  the  thyroid,  after  larger  doses  the  hyperactivity  may 
more  readily  be  followed  by  exhaustion,  in  which  case,  in  old 
age,  the  degeneration  of  the  thyroid  will  be  still  more  quickened. 

If  persons  with  a  degenerated  thyroid  can  take  large  quan- 
tities of  alcohol  without  getting  drunk,  on  the  other  hand,  those 
with  an  overactive  thyroid  cannot  stand  alcohol  so  well;  and 
that  the  latter  is  the  case  in  Graves's  disease  has  been  already 
shown  by  the  fact  such  people  can  exhibit  the  symptoms  of  intoxi- 
cation even  when  they  have  taken  no  alcohol  at  all.  Young  girls 
and  women  generally,  except  those  past  the  climacteric  age,  are 
very  sensitive  to  the  effects  of  alcohol,  and  easily  get  intoxicated, 
owing  to  the  fact  that  the  thyroid  is,  with  them,  more  active  on 
account  of  the  intimate  connection  between  it  and  the  ovaries. 
Thus,  during  thyroid  treatment  we  have  seen  intoxication  appear 
after  a  single  glass  of  claret  in  persons  who  previously  could 
drink  much  more  without  becoming  so  affected. 

During  treatment  with  thyroid  tablets  alcohol  is  not  well 
borne,  according  to  our  observations. 

It  is  probable  that  the  sexual  glands  have  also  something 


360  Old  Age  Deferred. 


in  common  with  this  question.  We  have  observed  that  people 
with  marked  sexual  inclinations  are  seldom  habitual  drunkards; 
in  fact,  we  do  not  recall  having  ever  come  across  an  instance; 
also,  among-  total  abstainers  men  of  strong  sexual  inclina- 
tion are  not  infrequently  met  with,  whereas  alcoholics  do 
not  usually  seem  to  care  much  for  the  fair  sex,  which  should 
surprise  us  the  less,  in  as  much  as  among  them  impotency  is  very 
frequent,  alcohol  in  large  quantities  always  having  a  baneful 
effect  on  the  sexual  glands.  In  small  quantities,  to  a  certain 
extent,  it  may  prove  stimulating  to  these  glands. 

It  is  an  interesting  fact  that  in  those  with  degenerated 
sexual  glands  there  is  always  a  greater  liking  for  alcohol;  thus 
women,  after  the  menopause,  have  a  greater  predilection  for 
spirits,  and  the  greatest  number  of  cases  of  drunkenness  in 
women  is  to  be  observed  among  such.  Eunuchs  also  have  a 
greater  inclination  for  intoxicating  agents  than  have  their  more 
fortunate  brethren  who  are  still  in  possession  of  their  sexual 
glands.  We  do  not  think  that  psychic  impulses,  consequent  on 
such  conditions,  can  be  of  sufficient  influence  to  explain  the  crav- 
ing for  alcohol,  except,  perhaps,  through  the  circumstance  that 
persons  deprived  of  the  active  sexual  glands  do  not  enjoy  a  high 
state  of  mental  activity  and  are  unable  to  judge  of  the  fatal  con- 
sequences of  the  drink  habit.  If  women,  after  the  menopause, 
exhibit  a  greater  inclination  to  drink,  we  think  it  cannot  be  ex- 
plained solely  by  their  seeking  to  drown  the  sorrows  of  lost  youth 
and  by  substituting  for  the  pleasures  of  sexual  life  those  of  the 
bottle.  This  may  certainly  influence  them  to  a  certain  degree, 
but  in  any  case  it  is  certain  that  without  the  possession  of  healthy 
sexual  glands  the  desire  for  stimulants  is  greater;  and  it  would 
seem  also  that  in  advanced  age  they  can  take  alcohol  more  freely 
than  in  their  prosperous  younger  days.  Such  persons  have  a 
partiality  for  strong  sweet  liqueurs.  Happily  such  women  are  in 
a  great  minority.  All  we  wish  to  point  out  is  that  it  is  among  the 
older  people  that  this  craving  exists,  as  in  the  younger  ones 
alcohol  cannot  be  so  well  borne. 


Prevention  of  the  Alcohol  Habit.  301 

From  such  observations  on  the  greater  frequency  of  the 
alcohol  habit  among  persons  suffering  from  degenerated  condi- 
tions of  the  thyroid  and  sexual  glands,  and  on  its  greater  rarity 
in  opposite  conditions,  we  believe  that  some  therapeutic  hints 
may  be  gained.  The  best  preventive  against  the  alcohol  habit 
(which  is  induced  usually  by  the  want  of,  and  a  real  craving 
for,  stimulants)  will  be  the  satisfying  of  this  tendency  by  other 
means  than  alcohol.  We  can  even  prevent  this  craving  if  we 
can  improve  the  state  of  their  thyroid  or  sexual  glands.  For 
single  persons  marriage  is  an  excellent  stimulant,  and  a  first- 
class  psychic  treatment  as  well.  Treatment  by  means  of  thyroid 
gland  can  also  give  good  results,  as  by  this  the  mental  condition 
will  be  improved  and  a  cheerful  disposition  may  be  gained,  which 
will  enable  them  the  better  to  withstand  worry  and  depression 
after  disappointment.  At  the  same  time  the  temperature  of  the 
body  will  be  increased,  a  feeling  of  warmth  produced,  and  fatigue 
much  better  borne.  Thus  no  whip  will  be  needed,  and  the  craving 
for  stimulants  will  be  prevented.  To  women  not  only  thyroid, 
but  ovarian,  extracts  should  be  given.  Both  exercise  a  powerful 
influence  on  the  mental  condition,  relieve  depression,  and  remove 
the  craving  for  constant  stimulation.  By  these  means  we  possess 
a  basis  for  the  rational  treatment  of  alcoholism,  besides  the 
psychical  and  ethical  one,  on  which  we  will  not  enter  here.  But 
we  must  emphatically  remark  that  we  must,  in  the  first  instance, 
get  rid  of  the  real  cause  of  alcoholism,  viz.,  the  diseased  condition 
of  the  thyroid  and  sexual  glands  which  induces  it,  and  by  the 
removal  of  the  cause  we  also  remove  the  consequences.  By 
merely  forbidding  the  use  of  alcohol  and  doing  nothing  to  cure 
the  diseased  condition  which  sets  up  such  an  insatiable  craving 
for  it,  is  like  rilling  a  barrel,  which  has  a  hole  in  it,  with  water, 
before  we  have  tried  to  stop  up  the  orifice. 


CHAPTER   XLIV. 

On    Other    Stimulants — Tea,    Coffee,    Cocoa,    Tobacco  : 
Their  Merits  and  Disadvantages. 

In  many  people  the  use  of  the  above  stimulants  produces 
greater  energy,  especially  for  mental  work,  and  the  process  of 
thought  may  be  facilitated  by  their  means,  although  we  are  not 
prepared  to  approve  them  as  a  general  rule.  At  any  rate  if  such 
properties  are  to  be  found  in  these  stimulants,  they  are  available 
only  in  small  amounts  and  not  exceeding  a  given  limit,  for  in 
excess  the  same  rule  applies  to  them  as  to  alcohol. 

There  are,  indeed,  certain  authorities  who  condemn  them, 
and  go  so  far  even  as  to  call  them  poisonous.  But  it  is  a 
leading  principle  of  this  work  to  condemn  exaggeration  and 
fanaticism  in  any  form,  and  always  to  observe  the  means  that 
are  best  for  all  rules  of  life.  Sobriety  and  impartiality  in  every- 
thing must  be  the  guiding  stars  for  such  a  work  as  this.  We 
must  not  forget  that  the  millions  of  human  beings  that  are  on  the 
earth  have  each  a  different  kind  of  constitution,  and  many  of 
them  practically  cannot  exist  without  the  assistance  of  certain 
stimulants,  without  which  life  would  be  a  burden  to  them ;  and 
as  it  does  no  good  to  make  prohibitions  which  cannot  be  kept, 
even  though  made  with  the  best  of  intentions,  all  we  can  do  is  to 
endeavor  to  control  certain  things  and  to  see  that  some  limit  is 
set  for  their  use. 

There  are  two  varieties  of  tea,  both  of  which,  however,  are 
gathered  from  the  same  plant ;  their  only  difference  lies  in  their 
method  of  preparation;  their  differentiation  is  in  color — black 
and  green.  The  former  undergoes  a  process  of  fermentation 
and  is  then  dried  slowly  over  charcoal  fires,  while  green  tea 
derives  its  color  from  having  been  dried  in  a  fresh  condition 
over  a  wood  fire. 
(362) 


Tea,  Coffee,  Cocoa,  Tobacco.  368 

When  we  want  to  make  good  tea  we  must  take  finely 
washed  leaves  and  make  an  infusion,  so  that  the  greatest  pos- 
sible surface  of  the  leaves  shall  come  in  contact  with  the  boiling 
water;  and  it  is  best  to  let  this  contact  be  only  for  a  short  time, 
as  otherwise  the  tea  will  be  too  strong  and  less  beneficial  to  health. 

The  most  important  elements  in  tea  are  thein,  a  substance 
that  is  identically  similar  to  caffein  in  coffee,  ethereal  oils,  tannin, 
and  extractives.  Green  tea  contains  more  thein  and  ethereal  oils, 
and  also  more  tannic  acid,  than  black  tea ;  and  the  longer  it  is  in 
contact  with  boiling  water  the  greater  will  be  the  quantity  of 
tannic  acid  derived  from  it.  According  to  R.  Hutchison,1  the 
ashes  of  tea  contain  a  large  percentage  of  manganates  (1.09  per 
cent,  manganese  hydroxide)  and  much' iron  (4.47  per  cent,  oxide 
of  iron). 

After  taking  a  cup  of  tea  there  is  a  feeling  of  great  com- 
fort; we  feel  lighter  and  less  fatigued,  which  is  due,  as  dis- 
covered by  Koch  and  Kraepelin,la  to  the  combined  action  of  the 
ethereal  oils  and  of  the  thein.  The  tannic  acid  contained  in  tea 
may  also  give  good  results  in  the  treatment  of  certain  diar- 
rhoeas. The  actions  of  tea  are  very  similar  to  those  of  coffee, 
which  is  only  natural,  since  both  contain  the  same  chemical  agent, 
thein  or  caffein.  Still,  though  chemically  the  same,  physiolog- 
ically doubtless  there  are  some  slight  differences.  Although  both 
promote  endurance  in  physical  and  mental  work,  according  to 
some  views,  still  in  many  people  nervous  irritability,  such  as 
sleeplessness,  is  greater  from  tea  than  from  coffee.  Coffee  is  a 
better  diuretic  than  tea,  and  it  has  been  found  that  common  salt  is 
eliminated  in  the  larger  quantity  after  taking  coffee.  For  weak 
stomachs  neither  is  advisable. 

In  many  cases  tea  is  less  easily  assimilated  than  coffee,  on 
account  of  digestive  disturbance  caused  by  its  tannin  contents; 
while  to  many  others  tea  proves  more  suitable  than  coffee. 
When  these  beverages  are  taken  in  large  quantities  there  are 


1  Hutchison:    "Food  and  the  Principles  of  Dietetics,"  London,  1901. 
laKoch  and  Kraepelin:     "Psychologies  die  Arbeiten,"  vol.  i,  p.  378,  1895, 


364  Old  Age  Deferred. 


very  serious  symptoms  of  nervous  disorders,  such  as  great  ex- 
citability, sleeplessness,  palpitation  of  the  heart,  trembling,  etc. 
Indeed,  sometimes  the  very  serious  condition  of  actual  intoxi- 
cation is  brought  about. 

It  is  quite  amazing  what  large  quantities  of  tea  are  con- 
sumed in  certain  countries — in  England,  for  example;  and  in 
many  instances  the  moderate  use  of  good  wine  would  cer- 
tainly create  less  mischief  than  the  immoderate  use  of  tea. 
Tea  is  not  so  beneficial  to  the  kidneys  as  coffee,  and  as  we  have 
mentioned  in  the  chapter  on  the  hygiene  of  the  kidneys,  irri- 
tation of  the  kidney  tissues  may  be  at  times  observed  after  the 
use  of  tea.  As  in  the  case  of  alcohol,  moderation  with  tea  and 
coffee  is  necessary.  According  to  the  researches  of  Bottger  even 
weak  infusions  of  tea  and  coffee  are  harmful  to  children,  and 
strong  infusions  to  grown  up  people. 

The  most  important  substance  in  coffee  is  caffein,  a  product 
already  mentioned  as  being  chemically  identical,  with  thein. 
When  we  take  a  cup  of  coffee  about  o.  i  gramme  of  caffein  enters 
the  system,  and  also  0.2  gramme  of  tannic  acid,  as  shown  by 
Robert  Hutchison..  When  coffee  is  roasted  aromatic  oils  arise, 
which  give  coffee  its  delicious  aroma.  Coffee  acts  as  a  stimulant 
to  the  heart  and  also  to  muscular  contractions.  Its  beneficial 
action  on  the  kidneys  has  been  referred  to.  When  coffee  is  taken 
it  is  more  hygienic  to  take  it  not  too  strong,  and  invariably  with 
cream  or  milk. 

According  to  Emil  Fisher,  caffein  is  a  thrice  methylated 
xanthin,  from  which  it  can  be  produced  artificially.  As  caffein, 
or  thein,  contains  purin  bodies,  they  also  augment  the  amount 
of  uric  acid  in  the  body,  and  especially  so>  when  they  are  taken  in 
large  quantities.  Because  coffee,  tea,  or  cocoa  give  rise  to  uric 
acid,  Haig  would  like  to  banish  them  entirely  from  the  diet.  We 
do  not  feel  inclined  to  follow  Haig  in  such  a  fanatical  view,  for 
after  all  it  is  nearly  impossible  to  so  live  that  we  should  not 
introduce  some  small  amount  of  uric  acid  into  the  system;  we 
are  always  producing  a  certain  amount  of  it  in  the  system,  as 


Tea,  Coffee,  Cocoa,  Tobacco.  365 

already  mentioned,  and  whether  a  trifle  more  or  less  be  taken  can 
make  no  difference,  as  minute  quantities  of  uric  acid  cannot  play 
an  important  role  if  our  kidneys  are  in  good  condition  to  elimi- 
nate them.  With  a  large  amount  of  meat  we  eliminate  two  grams 
of  uric  acid  in  every  twenty-four  hours,  and  even  with  an  entirely 
vegetarian  diet  the  urine  still  contains  0.2  to  0.7  gramme,  accord- 
ing to  Bunge.  Should  we  be  so  unreasonable  as  to  refuse  a 
person  a  cup  of  weak  tea  or  coffee,  after  their  having  been  accus- 
tomed to  such  for  a  lifetime,  merely  to  avoid  a  few  more  atoms  of 
uric  acid.  Especially  should  we  refuse  them  a  weak  cup  of  coffee, 
remembering  that  such  is  a  good  diuretic  and  assists  in  the  elimi- 
nation of  baneful  products  through  the  kidneys?  Only  to 
actually  gouty  people  might  such  a  veto,  perhaps,  be  reasonably 
applied. 

Cocoa  is  a  very  valuable  article  of  food,  and  at  the  same 
time  a  very  mild  stimulant.  As  its  active  principle  it  contains 
theobromin,  which  is  a  twice  methylated  xanthin.  In  its  chemical 
and  physiological  actions  theobromin  is  very  similar  to  caffein. 
It  is,  however,  in  some  respects  superior  to  caffein.  Thus  it  can 
assist  muscular  activity,  according  to  some  authorities,  to  a 
higher  degree  than  caffein  or  thein. 

Cocoa  has  the  further  advantage  of  being  more  digestible 
than  coffee  or  tea ;  and  as  a  foodstuff  it  shows  a  great  superiority 
over  both  the  latter,  as  it  contains  12  per  cent,  of  albumin,  13 
per  cent,  of  carbohydrates,  and  contains  fat — indeed,  about  50 
per  cent. — in  a  fresh  condition. 

Cocoa  presents  fewer  drawbacks  than  tea  or  coffee;  it  is 
less  exciting  to  the  nervous  system,  more  digestible,  and  much 
more  nutritious  also.  We  think,  therefore,  it  is  clearly  indicated 
as  the  best  of  all  stimulants,  and,  for  reasons  already  stated,  we 
are  not  afraid  to  recommend  it,  in  spite  of  the  fact  that  it  may 
nominally  increase  the  amount  of  uric  acid.  Cocoa  was  also  the 
favorite  beverage  of  the  great  botanist  Linne. 

Chocolate  is  composed  of  cocoa  and  a  large  quantity  of 
sugar,  and  is  quite  a  pleasant  sugar  food,  which  doubtless  can 


366  Old  Age  Deferred. 


be  used  with  profit  as  a  dessert  to  a  lacto-vegetarian  diet.  It  is 
also  suitable  for  the  use  of  tourists  and  sporting  men  in  order 
to  enable  them  the  better  to  endure  great  fatigue.  We  often 
recommend  its  use  in  its  best  quality  and  in  small  quantities  to 
those  people  from  whose  diet  meat  is  excluded. 

Tobacco  is  a  plant,  the  leaves  of  which,  when  prepared  by  a 
special  process  and  smoked  in  the  shape  of  cigars,  or  in  pipes, 
are  able  to  produce  in  many  people  a  feeling  of  exhilaration; 
and  many  such  smokers  are  able  to  do  more  work,  especially  brain 
work,  with  the  aid  of  a  good  cigar.  Tobacco  contains,  in  addi- 
tion to  noxious  salts,  a  poisonous  alkaloid,  nicotine,  which  pro- 
duces in  small  amounts  in  those  not  accustomed  to  it,  and  in  all 
people  if  in  larger  quantity,  a  condition  of  intoxication.  When 
nicotine  is  taken  for  many  years,  and  sometimes  even  in  a  shorter 
time,  either  by  smoking  or  chewing,  very  injurious  consequences 
from  nicotine  poisoning  may  ensue.  According  to  Konig,  cigar- 
ettes are  the  most  dangerous  in  this  respect.  It  is  quite  a  mistake 
to  think  that  no  nicotine  is  introduced  into  the  system  through 
smoking;  and  in  chewing  mixtures  the  presence  of  foreign 
matters  must  not  be  overlooked.  Nicotine  may  exercise  a  fatal 
action  on  various  organs — for  instance,  on  the  inner  parts  of  the 
eye  and  the  optic  nerve,  and  the  nervous  system;  but  without 
doubt  its  most  injurious  action  is  on  the  heart  and  the  stomach. 
At  first  it  may  cause  only  an  irregular  pulse  and  an  occasional 
feeling  of  a  stopping  of  the  heart;  but  if  continued,  in  spite  of 
these  symptoms,  for  a  long  time,  it  can  undoubtedly  produce  the 
condition  of  atheromatosis,  and  will  assist  in  the  development  of 
arteriosclerosis,  which  is  probably  caused  by  the  action  of  this 
substance  on  the  adrenals ;  for  it  has  been  noted  by  many  leading 
authorities — e.g.,  Prof.  Isaac  Adler,  of  New  York — that  tobacco 
produces  effects  similar  to  adrenalin. 

According  to  Sir  Lauder  Brunton2  and  others,  tobacco 
raises  the  blood-pressure,  sometimes  enormously.  As  Brunton 
says :  "I  do  not  know  that  there  is  anything  that  causes  such 
2  Brunton:     Lectures  on  the  Action  of  Medicine,  p.  321,  1897. 


Tea,  Coffee,  Cocoa,  Tobacco.  367 

a  tremendous  contraction  of  the  vessels  and  raises  blood-pressure 
to  such  an  enormous  extent  as  does  nicotine,  except,  perhaps,  the 
extract  of  suprarenal  capsules,  which  has  an  action  almost 
identical  with  nicotine." 

It  has  also  been  shown  by  Esser3  that  chronic  nicotine 
poisoning  is  able  to  produce  in  animals  a  great  disturbance  of 
the  heart  and  histological  alterations  of  the  vagus  fibers,  and 
that  if  nicotine  is  injected  into  the  circulation  it  excites  the  vagus 
and  slows  the  action  of  the  heart. 

Clinically  we  have  observed  the  great  frequency  of  arterio- 
sclerosis in  great  smokers,  but  we  do  not  think  that  two  or  three 
light  cigars  a  day,  but  never  before  meals,  can  do  any  harm, 
save  in  exceptional  cases.  Indeed,  there  are  a  few  instances  of 
persons  living  to  be  over  ioo,  notwithstanding  the  fact  that  they 
were  smokers — a  fact  contrary  to  the  observations  of  Hufeland, 
who  pretends  that  he  never  heard  of  such  a  case.  The  famous 
English  painter,  Mr.  Frithe,  who  died  in  October,  1909,  used  to 

smoke  six  cigars  a  day;  and  Mr.  F ,  of  Chartres,  in  France, 

passed  last  year  his  100th  birthday  in  spite  of  his  having  taken 
snuff  all  his  life. 


3  Esser:     Arch,  fiir  exper.  Path,  und  Pharm.,  xlix,  p.  168. 


CHAPTER  XLV. 

On  Sleep,  and  Its  Importance  in  Ridding  the  Body  of 
Toxic  Products. 

Sleep  is  one  of  the  most  important  functions  of  the  body. 
As  the  physiologist,  Bunge,1  remarks,  "a  man  can  live  for  a 
month  without  food,  but  he  must  succumb  after  only  a  few  days 
if  he  fails  to  sleep." 

That  sleeplessness  leads  to  death  has  been  proved  by  experi- 
ments on  animals  by  Maria  de  Manasseine,  who  has  demon- 
strated that  animals  from  three  to  four  months  old  invariably 
died  if  treated  in  such  manner  that  they  could  not  sleep  at  all.  At 
the  same  time  their  temperature  fell  four  to  five  degrees,  and  the 
number  of  their  red  blood-corpuscles  decreased  from  five  millions 
to  two  millions  per  cubic  millimeter.  Manasseine  also  discovered 
important  changes  in  the  brain  of  animals  which  had  died  from 
sleeplessness. 

Before  we  get  sleepy,  as  a  rule,  we  feel  tired  and  suffer 
from  fatigue.  Working  from  morning  to  night — for  even  idle 
persons  work  through  the  action  of  their  organs — our  mus- 
cles make  numerous  contractions,  and  it  has  been  demonstrated 
by  Weichardt2  that  toxic  products  are  thus  accumulated  in  them. 
This  savant  made  animals  perform  very  fatiguing  movements  for 
several  consecutive  hours;  he  then  injected  extracts  from  those 
muscles  which  had  been  subjected  to  such  exercise,  into  other 
animals,  which  animals  in  turn  exhibited  symptoms  of  great 
fatigue;  and  he  has  gone  so  far  as  to  show  that  such  animals 
may  even  die  during  the  next  twenty  to  forty  hours. 

Similar  conditions  prevail  in  human  beings  to  a  greater 
or  less   degree.     According  to  Prof.   Obersteiner,   of   Vienna, 


i  Bunge :     Log.  cit. 

2  Weichardt:      Munchener   Med.    Wochenschrift,   Nu.    1,    1904;     and  Ver- 
handlungen  der  Physiolog.  Gesellschaft,  Berlin,  Dee.  5,  1906. 

(368) 


Sleep  and  Ridding  the  Body  of  Toxic  Products.        369 

and  Binz,  sleep  is  produced  by  an  accumulation  of  the  products 
of  fatigue  in  the  brain,  and  these  substances  are  carried  off  dur- 
ing sleep.  Thus  sleep  is  similar  to  a  condition  of  autointoxi- 
cation caused  by  the  accumulation  of  the  products  of  work,  be 
it  muscular  or  mental,  during  the  time  that  we  are  awake. 

In  the  next  chapter  we  shall  show  that  sleeplessness  occurs 
in  all  cases  where  the  thyroid  gland  is  degenerated.  This  gland, 
as  we  show  in  different  parts  of  this  book,  destroys  the  toxic 
products  formed  in  the  body.  When  this  gland  is  degenerated 
these  products  cannot  be  destroyed,  and  thus  a  condition  of 
autointoxication  will  follow,  as  in  myxcedema,  which  has  sleep- 
lessness as  one  of  its  most  typical  symptoms. 

According  to  our  present  physiological  knowledge  the  cen- 
ter of  sleep  is  seated  in  the  brain  just  as  are  other  functions,  such 
as  intelligence,  will  power,  imagination,  etc.  As  we  have 
mentioned  in  the  chapter  on  the  agencies  which  control  the 
condition  of  our  nervous  system  and  mentality,  all  these  are 
changed  when  the  thyroid  is  altered,  for  they  suffer  alteration 
after  the  thyroid  is  removed  or  destroyed  by  disease ;  and,  on  the 
other  hand,  they  can  be  improved  by  thyroid  treatment.  Thus, 
sleep  being  one  of  these  functions,  it  is  only  logical  to  assume 
that  the  thyroid  controls  sleep,  which  proposition  we  shall  sup- 
port with  a  mass  of  evidence  in  our  next  chapter;  we  will  also 
mention  there  that  after  the  injection  of  adrenalin,  in  the  vicinity 
of  the  brain,  Dr.  Zeigan3  has  produced  sleepiness  in  animals. 
Adrenalin  produces  an  anaemic  condition  of  the  parts  into  which 
it  is  injected,  caused  by  the  contraction  of  the  blood-vessels. 

There  has  been  a  dispute  on  this  question,  whether  it  is 
hypersemia  of  the  brain,  or  its  anaemic  condition,  which  induces 
sleep. 

In  addition  to  the  experiments  of  Dr.  Zeigan,  which  we 
have  referred  to,  and  with  which  we  will  deal  further  in  our 
next  chapter,  there  are  also  other  circumstances  which  support 
the  idea  that  in  sleep  the  brain  must  be  in  an  anaemic  condition. 

3  Zeigan:     Therapeutische  Monatshefte,  p.  193,  1904. 

24 


370  Old  Age  Deferred. 


We  know  that  in  order  to  fall  asleep  the  brain  must 
be  at  complete  rest,  for  otherwise  it  is  impossible  to  sleep; 
if  the  function  of  the  brain  is  roused  by  any  exciting  influ- 
ence, as  for  instance,  if  we  ponder  deeply  over  any  scientific 
problem,  sleep  is  out  of  the  question.  We  think  this  can  be  amply 
proved  by  a  very  interesting  experiment  carried  out  by  the  physi- 
ologist, Mosso,  in  order  to  show  that  the  process  of  thought 
produces  a  hypersemia  of  the  brain.  Mosso  made  a  man  lie 
horizontally  on  a  sort  of  scale,  so  that  the  balance  was  perfectly 
level.  The  subject  was  then  told  to  think  deeply,  and  upon  so 
doing  the  head  end  became  heavier,  and  the  balance  was  depressed 
in  that  direction. 

We  can  also  note  that  any  other  agency  which  produces  a 
greater  flow  of  blood  to  the  brain  will  be  an  impediment  to  sleep. 
For  instance,  many  people  r.re  unable  to  sleep  when  they  have 
taken  a  certain  amount  of  alcohol,  such  as  wine,  just  before 
going  to  bed;  and  this  is  more  observable  in  those  who  are  un- 
accustomed to  alcohol,  and  who  become  flushed,  feel  hot  in  the 
head,  and  become  mentally  excited  after  taking  even  small  quanti- 
ties. On  the  other  hand  persons  accustomed  to  spirit  drinking,  in 
whom  no  such  symptoms  are  exhibited,  may  possibly  be  able 
to  sleep ;  this  demonstrates  toxic  action,  which  may  be  followed 
by  deep  sleep,  by  the  action  of  alcohol  on  the  thyroid  gland. 
Taken  in  small  quantities  alcohol  excites  thyroid  action,  but  taken 
in  large  quantities  it  causes  its  exhaustion  as  already  previously 
mentioned. 

Long  ago  it  was  accepted  as  a  well-known  fact  that  a  hot 
head  and  flushed  face  prevent  good  sleep ;  but  good  regular  sleep 
is  obtained  when  the  head  is  cold. 

Sleepiness  after  dinner  is  attributed  by  Bunge  to  the  ac- 
cumulation of  blood  in  the  digestive  organs,  which  produces  an 
anaemia  of  the  brain.     As  we  show  in  the  next  chapter,  the  altera- 
tion in  the  thyroid  by  its  destruction  of  toxic  products  from  the- 
intestine,  may  also  in  part  do  this. 

Very   interesting   experiments    have   been    carried    out    by 


Sleep  and  Ridding  the  Body  of  Toxic  Products.        ;J71 

Christern,4  under  the  direction  of  Prof.  Kreis,  of  Freiburg, 
who  showed  that  the  pressure  of  blood  in  the  cavity  of  the  skull 
of  a  boy  decreased  while  he  was  asleep. 

As  we  have  already  stated,  sleep  is  attributed  generally  to 
a  condition  of  autointoxication.  When  we  rise  in  the  morning, 
after  having  slept  well  and  soundly  during  the  night,  we  feel  so 
fresh  that  these  toxic  products  must  assuredly  have  left  the  body 
during  the  night.  On  the  other  hand,  after  a  sleepless  night  we 
feel  so  miserable  and  weak  that  the  supposition  is  not  unjustified 
that  possibly  we  have  not  gotten  rid  of  these  harmful  products. 
Professor  Bouchard  has  endeavored  to  show,  by  an  examination 
of  urine  passed  during  the  night,  that  this  has  a  greater  toxic 
action  when  injected  into  animals  than  has  urine  passed  during 
the  day. 

As  before  mentioned,  according  to  Obersteiner  and  Binz, 
during  sleep  the  products  of  fatigue,  which  have  accumulated  in 
the  brain  during  the  day,  are  removed  by  the  blood. 

Everything  points  to  the  fact  that  through  sleep  we  are 
getting  rid  of  toxic  products :  and  sleep  is  thus  a  function,  the 
regularity  of  which  is  of  the  utmost  importance  for  our  pros- 
pects for  a  prolonged  youth  and  healthy  old  age. 

4  Quoted  after  Bunge. 

5  Bouchard :     hoc.  cit. 


CHAPTER   XLVI. 
On  the  Causation  of  Sleep,  Sleepiness,  and  Insomnia. 

When  any  one  is  affected  by  African  sleeping  sickness,  he 
wants  to  sleep  at  all  times.  We  observed  the  case  of  an  officer 
of  the  Belgian  Congo  Army,  suffering  from  this  sickness,  who 
actually  feel  asleep  over  his  soup  while  at  table.  Dr.  Willems, 
of  Brussels,  also  mentions  a  case  of  a  patient  who  fell  asleep 
during  his  wedding,  and  of  another  who  went  to  sleep  on  the 
doorstep  while  in  the  act  of  calling  on  him  for  advice. 

Discovery  of  the  cause  of  such  a  marked  degree  of  sleepiness 
caused  by  disease  should  be  of  the  greatest  possible  assistance  in 
solving  the  mystery  which  enshrouds  the  lesser  degree  of  sleepi- 
ness found  in  normal  cases.  We  will,  therefore,  now  dis- 
cuss the  question  of  the  cause  of  the  uncontrollable  desire  to 
sleep  in  cases  of  sleeping  sickness. 

As  we  pointed  out  in  a  communication  to  the  German  Con- 
gress of  Medicine  in  Wiesbaden,  in  1905,  sleeping  sickness  is 
clinically  and  essentially  a  condition  quite  different  to  trypanoso- 
miasis. It  undoubtedly  is  the  consequence  of  the  former,  which 
is  caused  by  the  bite  of  the  tsetse  fly  (Glossina  Palpalis)  ;  but 
sleeping  sickness  presents  entirely  different  clinical  symptoms  from 
the  first,  and  it  also  takes  a  much  longer  time,  sometimes  five  to 
seven  years,  to  develop,  after  the  preceding  trypanosomiasis. 

As  we  could  not  fail  to  observe,  the  above  case  presented 
all  the  appearances  of  a  myxoedematous  condition,  among 
others  the  same  walk,  slowness  of  movement  and  of  speech,  and 
the  same  apathetic  mental  state,  with  the  same  dullness  of  mem- 
ory; and  it  was  surprising  to  witness  how  all  these  symptoms 
improved  only  a  few  days  after  thyroid  treatment  had  been 
instituted. 

The  pathological  and  anatomical  changes  in  patients  suffer- 
(372) 


Causation  of  Sleep  and  Insomnia. 


ing  from  African  sleeping  sickness,  described  by  tbe  English  and 
Portuguese  Commission  charged  with  the  study  of  this  disease, 
present  also  a  great  similarity  to  the  changes  found  in  myx- 
cedema,  and  this  is  especially  the  case  in  connection  with  the 
central  nervous  system.  Thus  we  find  in  both  conditions  similar 
changes,  such  as  destruction  of  the  nerve  cells  and  nerve 
processes,  chromatolysis,  disappearance  of  the  Nissl  bodies,  and 
also  the  same  typical  agglomeration  of  white  blood-corpuscles  in 
and  around  the  blood-vessels,  etc.  The  most  striking  point  in 
reference  to  this  similarity  is  the  fact  that  the  condition  in  the 
central  nervous  system  is  in  both  conditions  named  alike,  viz., 
pylo-encephalo-myelitis.  Walter  Edmunds  has  found  similar 
changes  in  dogs  and  monkeys  after  removal  of  the  thyroid. 

This  singular  similarity  also  coincides  with  the  etiology 
of  the  two  conditions.  Myxcedema  is  most  often  the  conse- 
quence of  a  previous  infectious  disease ;  in  the  case  of  sleeping 
sickness,  this  previous  infectious  disease  is  trypanosomiasis.  In 
trypanosomiasis  we  find  all  the  symptoms  of  Graves's  disease. 
In  the  chapter  on  the  agencies  which  grant  us  immunity  against 
infections  and  intoxications,  we  explain  the  presence  of  the  symp- 
toms of  Graves's  disease.  The  symptoms  of  trypanosomiasis  can 
be  explained  in  the  same  way,  as  can  those  which  occur  in  other 
infectious  diseases,  as  they  are  expressions  of  the  defense  of  the 
thyroid  against  infection.  The  consequence  of  such  overwork  of 
the  thyroid  is  its  degeneration,  which  results  in  the  symptoms  of  a 
myxcedematous  condition,  as  found  in  sleeping  sickness. 

According  to  Koch,  arsenic,  in  the  form  of  atoxyl,  can  give 
good  results  in  such  a  condition;  but  with  arsenic  we  introduce 
one  of  the  main  elements  contained  in  the  thyroid  gland,  and 
arsenic  can  also  afford  favorable  results  in  the  treatment  of 
myxcedema. 

The  most  typical  symptom  of  African  sleeping  sickness  is 
the  great  somnolence  which  cannot  be  controlled  or  resisted, 
as  stated  in  the  few  examples  given  above.  This  somnolence  is 
also  one  of  the  typical  symptoms  of  myxcedema,  being  according 


Old  Age  Deferred. 


to  Pilcz,  one  of  the  four  cardinal  symptoms  of  this  disease.  We 
also  find  this  in  animals  or  persons  in  which  the  thyroid  has  been 
removed.  We  have  observed  dogs  in  which  this  has  been  done, 
and  they  were  always  so  fast  asleep  that  the  loudest  noise  could 
not  rouse  them.  From  the  foregoing  there  can  be  no  doubt  that 
the  thyroid  gland  has  something  to  do  with  sleep,  and  this  is  best 
exemplified  by  the  circumstance  that  there  is  sleepiness  in  all 
those  conditions  where  the  thyroid  gland  is  degenerated,  as  in 
the  instances,  just  quoted,  of  myxcedema  and  of  animals  in  which 
the  thyroid  has  been  removed.  In  addition  to  these  examples, 
sleepiness  can  also  be  observed  in  cases  of  tumors  of  the  pituitary 
body — for  instance,  in  acromegaly.  However,  as  has  been 
shown  by  Gley,  Rogowitscli,1  Stieda,2  Sajous,3  and  others,  the 
pituitary  gland  and  the  thyroid  are  in  a  very  close  relationship, 
and,  as  I  have  also  pointed  out  in  a  previous  paper,  we  find  pretty 
constantly  alterations  of  the  thyroid  gland  in  acromegaly. 
Salmon  also  mentions  that  in  tumors  of  the  pituitary  body,  with 
sleepiness,  there  was  generally  found  an  atrophic  condition  of 
the  thyroid. 

Sleepiness  is  frequently  observed  in  certain  cases  of  obesity. 
Such  a  condition  was  described  several  years  ago,  under  the 
name  narcolepsy,  by  Sainton.  I  have  also  observed  similar  cases. 
Thus,  an  English  patient  of  mine,  a  gentleman  weighing  260 
pounds,  would  fall  asleep  on  any  occasion — in  church,  at  the 
theatre,  and  at  concerts ;  and  I  have  heard  of  a  similar  case  from 
a  confrere  (related  to  me  by  Dr.  Echlin,  of  Ottawa),  who  was 
a  very  fat  man  and  who  snored  much  louder  during  an  operation 
than  did  the  narcotized  young  lady,  whom  Dr.  Echlin  was  operat- 
ing on  for  appendicitis. 

The  sleepiness  in  these  cases  must  also  be  attributed  to  the 
thyroid  gland,  which  governs  metabolism,  as  shown  by  the 
researches  of  Prof.  Magnus  Levy,4  of  Berlin,  Thiele,  Nehring, 

1  Loc.  cit. 

2  Loc.  cit. 

3  Sajous :     Loc.  cit. 

4  Path,  des  Stoffwechsels  of  v,  Noorden,  second  edition,  vol.  ii. 


Causation  of  Sleep  and  Insomnia.  375 

etc.,  and  also  by  my  own  works.  The  fat-reducing  action  of 
thyroid  extracts  confirms  this  clearly. 

Sleepiness  is  a  frequent  symptom  of  chlorosis ;  and  it  is  a 
fact  that  in  chlorosis  the  thyroid  is  very  often  altered,  which 
might  thus  explain  it. 

Sleep  produced  by  narcotics  and  alcohol  can  also  be  brought 
in  relation  with  altered  thyroid  functions.  We  have  already 
mentioned  that  we  have  observed  during  narcosis  with  chloro- 
form and  ether  a  marked  swelling  of  the  thyroid  gland,  indi- 
cating a  condition  of  hyperactivity,  which  is  followed  by  exhaus- 
tion; and  after  previous  mental  excitation,  depression  and  sleep 
follow.  The  action  of  alcohol  on  the  thyroid  has  also  been 
explained  in  a  previous  chapter  on  alcohol. 

The  sleepiness  we  notice  after  a  heavy  dinner,  and  more 
particularly  after  partaking  of  a  large  amount  of  meat,  can  also 
be  traced  to  thyroid  changes ;  for  we  know  that  the  thyroid  gland 
destroys  toxic  products  formed  in  the  intestines,  especially  those 
toxines  caused  by  the  destruction  of  albuminoids,  as  shown  by 
Blum. 

The  best  proof,  however,  of  the  truth  of  the  assertion  that 
a  degenerated  state  of  the  thyroid  produces  sleepiness,  is  to  be 
found  in  the  fact,  which  we  have  established  by  a  number  of 
observations  on  patients,  and  also  on  ourselves,  that  the  serum  of 
animals,  in  which  the  thyroid  has  been  removed,  causes  sleep. 
We  will  deal  more  fully  with  this  in  our  next  chapter  on  the 
treatment  of  sleeplessness. 

If  sleepiness  is  so  frequent  in  all  degenerative  changes  of 
the  thyroid,  on  the  other  hand  insomnia  is  the  rule  in  cases  of 
hyperactivity  of  the  thyroid  gland,  as  in  Graves's  disease,  in 
which  we  know  there  exists  a  condition  of  hyperactivity  of  the 
thyroid.  We  also  find  insomnia  in  diabetes,  but  only  in  the 
preliminary  stages,  where  there  is  no  acetone  and  diacetic  acid  in 
the  urine.  In  severe  cases  we  often  find,  on  the  contrary, 
sleepiness ;  and  this  may  be  attributed  to  the  fact  that  severe 
cases  of  diabetes  present  features  of  a  myxcedematous  condition, 


376  Old  Age  Deferred. 


as  we  have  found  by  the  disappearance  of  the  acetone  and  diacetic 
acid  through  treatment  with  thyroid  extracts.  Sleeplessness 
can  also  be  produced  artificially  by  giving  thyroid  preparations 
in  large  quantities. 

If  sleepiness  may  be  produced  by  thyroid  degeneration,  and 
sleeplessness  through  thyroid  hyperactivity,  the  conclusion  is 
not  unjustified  that  the  thyroid  exerts  a  controlling  influence 
upon  sleep;  it  is,  however,  quite  possible  that  the  other  ductless 
glands  may  also  influence  sleep. 

Subsequently  to  my  communication  to  the  German  Congress 
of  Internal  Medicine  in  1905,  wherein  I  showed  that  the 
thyroid  governs  sleep,  Dr.  Salmon,  of  Florence,  in  a  monograph 
on  sleep,  tried  to  show,  without  any  knowledge  of  my  commu- 
nication, that  sleep  is  governed  by  the  pituitary  body.  As,  how- 
ever, the  pituitary  body  and  the  thyroid  are  in  close  relationship, 
and  as  Salmon  also  mentions  that  in  cases  of  tumors  of  the 
pituitary  body  the  thyroid  has  been  found  atrophic,  I  am  inclined 
to  attribute  the  primary  role  to  the  thyroid.  We  can  produce 
sleepiness  by  the  serum  of  thyroidectomized  animals,  and  sleep- 
lessness by  thyroid  extracts ;  but  we  do  not  yet  know  any  similar 
facts  about  the  pituitary  body. 

From  the  communications  of  various  authorities,  it  appears 
possible  also  that  the  adrenals  influence  sleep  as  first  pointed  out 
by  Professor  Sajous  in  1903  in  the  first  volume  of  his  work 
(p.  520)  on  the  Internal  Secretions.  Dr.  Zeigan5  injected  a 
milligramme  of  adrenalin,  mixed  with  5  grammes  of  physiologi- 
cal salt  solution,  into  the  vicinity  of  the  brain  of  cats,  producing, 
within  one  minute,  a  deep  sleep  lasting  from  thirty  to  fifty 
minutes;  and  when  the  cats  awoke  they  remained  very  drowsy 
for  some  time  afterward. 

From  the  above  observations  therapeutic  conclusions  may 
also  be  deduced,  as  we  will  show  in  the  chapter  on  the  treatment 
of  sleepiness  and  sleeplessness. 


5  Therapeutische  monatshefte,  p.  193,  1904. 


CHAPTER  XLVII. 
Hygiene  of  Sleep — Prevention  of  Insomnia. 

We  are  all  acquainted  with  the  tale  of  the  man  who  was 
blind  in  one  eye  and  deaf  in  one  ear,  who  at  once  went  to 
sleep  when  his  sound  eye  and  ear  were  closed.  In  this  case  there 
was  nothing  to  stimulate  the  centers  of  perception  in  the  brain. 

This  example  is  very  instructive  for  the  question  we  shall 
now  have  to  discuss.  The  best  hygiene  of  sleep  is  to  avoid  all 
agencies  that  may  cause  excitation  of  the  brain.  We  have 
seen,  in  the  preceding  chapter,  that  an  anaemic  condition  of 
the  brain  must  be  sought;  and  this  is  best  attained  when  the 
brain  is  at  complete  rest  and  nothing  is  acting  on  it  which  may 
cause  an  afflux  of  blood,  and  thus  hinder  an  anaemic  condition. 
A  sleeping  brain  must  not  work,  as  any  kind  of  mental  labor, 
even  the  smallest  noise,  when  it  is  able  to  attract  attention  by 
having  been  conveyed  to  the  centers  of  perception,  may  impede 
sleep.  Sometimes  the  loudest  noise,  such  as  an  electric  car  pass- 
ing with  bell  ringing,  will  not  awaken  us,  or  prevent  our  falling 
asleep,  if  we  are  accustomed  to  it;  for  it  will  then  excite  no 
attention  and  consequently  will  cause  no  work  for  the  brain ;  but 
should  some  one  speak  loudly  in  an  adjoining  room,  or  should  any 
unusual  noise  occur  in  our  vicinity,  although  infinitely  less  than 
the  above  mentioned,  it  may  be  sufficient  to  prevent  our  sleeping, 
for  we  pay  more  attention  to  it,  and  thus  the  repose  of  the  brain 
is  prevented. 

The  miller  will  sleep  soundly  in  spite  of  the  rumbling  of 
his  mill  wheels,  to  which  he  has  been  accustomed  for  years ;  but 
should  the  mill  stop  he  may  awake,  for  this  would  arrest  his 
attention. 

From  the  foregoing  it  follows  logically  that  in  order  to  sleep 
soundly  it   is  best  to  exclude  everything  that  can   arouse  the 

(377) 


378  Old  Age  Deferred. 


organs  of  perception,  and  which,  if  conveyed  to  the  brain,  may 
invite  attention  and  thereby  brain  work.  We  must,  therefore, 
exclude  noise  and  light  from  our  sleeping  chamber,  as  we  all 
know  from  personal  observation  that  we  sleep  soundest  in  a 
room  that  is  thoroughly  darkened  and  where  no  noise  can 
penetrate. 

Some  people  are  accustomed  to  a  slight  light  in  the  room 
during  the  night,  for  complete  darkness  would  create  attention, 
and  thus  they  would  not  be  able  to  sleep  so  well.  For  such  the 
light  through  the  transom  will  be  advantageous;  but  for  many 
people  such  light  would  prevent  them  falling  asleep. 

When  a  sleeping  chamber  is  too  warm  we  may  be  prevented 
from  sleeping;  people  mostly  sleep  best  in  a  room  that  is  not 
warmed,  as  this  favors  an  anaemic  condition  of  the  brain  and 
excludes  the  sensation  of  heat  that  is  adverse  to  sleep.  We  also 
sleep  better  in  autumn  and  winter  than  in  summer,  unless  the 
room  be  heated  and  an  artificial  summer  created  thereby. 

The  air  in  the  room  must  not  be  oppressive,  so  as  not  to 
invite  the  attention  of  our  senses  of  perception ;  it  would,  there- 
fore, be  wisest  to  take  the  largest  room  in  the  house  to  sleep  in, 
and  not  the  smallest,  as  many  do.  People  with  a  large  bedroom 
and  small  sitting-room  will  have  more  chances  for  a  long  life 
than  those  reversing  this  order  of  things.  A  hygienic  bedroom 
must  be  large,  not  heated  during  the  night,  and  the  upper  part 
at  least  of  the  window  should  always  be  open,  and  preferably 
one  at  a  part  of  the  house  facing  a  large  garden  or  open  space. 

In  order  that  the  brain  may  be  at  rest  it  is  essential  that 
the  other  organs  should  also  be  resting.  Any  organ  that  is 
working,  particularly  if  the  work  be  laborious,  or  if  the  organ 
be  diseased,  will  send  impulses  to  the  brain.  It  is  very  difficult 
to  sleep  if  any  part  of  the  body  is  aching;  the  sensory  nerves 
bring  this  to  the  center  of  perception  in  the  brain,  and  this 
awakens  us.  When  the  stomach  is  loaded  we  may  the  sooner 
drop  to  sleep,  for  reasons  mentioned  in  the  preceding  chapter ;  but 
digestion  during  sleep  is  more  labored,  and  thus  again  impulses 


Prevention  of  Insomnia.  379 

will  be  sent  to  the  brain.     The  same  occurs  when  the  intestines 

are  filled  with  gases. 

This  necessitates  the  practical  advice  not  to  eat  too  much 
for  supper,  and  particularly  not  to  go  to  bed  for  some  two  and 
a  half  to  three  hours  at  least  after  that  meal ;  and  most  people 
will  sleep  better  if  they  do  not  take  much  meat,  and  for  such  as 
suffer  from  sleeplessness  not  any  meat  at  all,  at  night.  The  most 
hygienic  hour  for  our  evening  meal  would  be  about  7  o'clock,  not 
later;  and  for  the  prevention  of  sleeplessness  6  o'clock  is  better. 

But  if  it  is  difficult  to  sleep  with  the  stomach  full,  an  empty 
stomach  may  also  cause  difficulties,  particularly  when  there  is  much 
hydrochloric  acid  in  the  stomach.  A  glass  of  milk  and  a  biscuit 
is  a  good  remedy  if  awakened  from  such  causes. 

Flatulency  also  may  often  be  the  cause  of  disturbed  sleep, 
and  to  prevent  this  certain  kinds  of  food,  liable  to  cause  it,  should 
not  be  taken  in  the  evening;  such  are  beans,  peas,  or  lentils,  and 
potatoes  especially,  if  beer  be  taken  at  the  same  time.  By  such 
combinations  a  regular  chemical  laboratory  in  the  intestines  will 
be  formed  during  the  night,  and  for  five  to  six  hours  after  such  a 
meal,  or  longer,  according  to  the  time  we  go  to  bed,  sleep  will  be 
disturbed.  So  long  as  there  is  flatulency  it  is  impossible  to  sleep, 
and  the  quickest  way  to  put  an  end  to  it  is  to  insert  a  supposi- 
tory of  glycerine  into  the  rectum,  which  will  soon  cause  a  copious 
evacuation,  provided  that  the  intestines  have  not  been  previously 
weakened  by  too  many  drugs.  After  this  remedy  the  flatulency 
will  cease,  and  sound  sleep  for  the  rest  of  the  night  will  follow. 

Many  people  are  apt  to  awake  during  the  night  after  five 
or  six  hours'  sleep  if  they  have  partaken  of  much  meat  at  the 
evening  meal  and  then  gone  at  once  to  bed.  Only  to  catch  an 
early  morning  train  would  it  be  permissible  to  commit  such  a 
breach  of  the  true  hygiene  of  sleep.  To  observe  this  hygiene  fully 
we  must  also  avoid  taking  mineral  waters  with  diuretic  action  for 
some  time  before  going  to  bed,  for  the  dilatation  of  the  bladder 
from  the  accumulated  urine  may  convey  sensations  to  the  brain 
and  thus  disturb  sleep. 


380  Old  Age  Deferred. 


Total  sexual  abstinence  may  cause  insomnia,  especially  in 
persons  who  do  not  observe  complete  chastity;  for  this  marriage 
is  the  best  preventive,  as  it  is  for  other  troubles  of  a  like  nature. 

In  women,  when  menstruation  comes  on,  there  is  also  dis- 
turbed sleep  very  frequently;  and  many  unmarried  women  suffer 
from  insomnia. 

Sleep  can  the  more  easily  be  disturbed  when  it  is  the  lightest, 
which  is  generally  the  case  during  the  early  morning,  for  which 
reason  at  this  period  all  noise  should  be  most  carefully  avoided. 
Sleep  about  midnight  is  generally  the  deepest,  and  a  noise  that 
would  not  disturb  us  at  that  hour  will  frequently  do  so  in  the 
early  morning  hours ;  thus,  the  midnight  hours  being  the  best 
for  sleep,  it  seems  advisable  to  go  to  bed  about  ten  or  half-past  ten, 
and  it  is  certainly  not  hygienic  to  retire  after  twelve,  as  then  it  is 
more  difficult  for  most  people  to  get  asleep  than  it  is  at  ten  or 
eleven. 

It  follows  from  the  preceding  considerations  that  mental 
work  in  the  hours  before  going  to  bed  will  be  contrary  to  the 
hygiene  of  sleep.  When  the  brain  is  engaged  in  intense  thought 
there  is  an  afflux  of  blood  thereto,  as  mentioned  before. 
It  takes  some  time  before  the  brain  becomes  sufficiently  anaemic 
for  sleep;  for  which  reason  also  it  is  not  wise  to  read  books, 
especially  interesting  ones,  in  bed.  It  is  a  very  bad  habit  to  read  in 
bed  until  late  in  the  night,  as  is  done  by  many  ladies  who  complain 
of  insomnia  and  take  somnifacient  drugs  instead  of  extinguishing 
the  light  as  soon  as  they  go  to  bed,  and  excluding  all  agencies  that 
may  excite  their  attention,  in  order  to  allow  the  brain  to  come  to 
a  state  of  rest. 

We  must  now  answer  the  question :  How  many  hours'  sleep 
shall  we  indulge  in? 

On  an  average,  for  the  adult  male,  six  to  seven  hours'  sleep 
is  necessary  to  feel  rested  thereafter  and  to  fully  appreciate  the 
saying  that  "Sleep  is  Nature's  sweet  restorer."  Young  girls 
and  women  require  much  more  sleep  than  do  men;  but  children, 
and  especially  infants,  require  the  most. 


Prevention  of  Insomnia.  381 

Infants  are  usually  almost  always  asleep,  possibly  owing  to 
the  fact  that  the  thyroid  and  other  ductless  glands  are  not  yet 
fully  active ;  and  for  this  reason  children  also  require  longer 
sleep.  The  older  we  get  the  less  sleep  we  require.  Sometimes 
in  old  age  there  is  obstinate  insomnia,  which  is  due  to  changes 
in  the  blood-vessels  of  the  brain,  by  which  high  blood-pressure  is 
caused  and  the  anaemic  condition  of  sleep  prevented. 

It  is  unwise  to  say  you  must  sleep  six,  seven,  or  eight  hours 
to  have  enough.  Each  individual  requires  a  different  time  accord- 
ing to  his  bodily  requirements,  which  he  must  study  by  careful 
observation.  The  deeper  the  sleep,  the  shorter  will  be  the  time 
that  will  be  required  for  it.  The  essential  thing  is  to  feel  rested 
in  the  morning,  and  it  does  not  matter  if  we  have  slept  only  five 
and  one-half  hours  if  we  only  feel  that  we  have  slept  enough. 
There  are  many  people,  usually  over  50  years  of  age,  who  feel 
rested  and  perfectly  well  after  but  five  hours'  sleep.  But  if  after 
even  seven  hours'  sleep  we  still  have  a  feeling  of  weariness  and 
depression,  so  to  speak,  we  have  not  freed  the  body  of  toxic  prod- 
ucts during  sleep,  so  the  time  was  insufficient  and  must  be  made 
up  the  following  night. 

It  is  a  very  strange  thing,  when  we  have  not  been  able  to 
sleep  long  enough  for  one  or  two  nights,  and  we  do  not  feel  in 
good  condition  in  consequence,  that  a  longer  sleep  on  the  third 
night  will  be  able  to  restore  us  entirely.  I  believe  this  is  a  clinical 
argument  in  favor  of  the  theory  that  sleep  serves  to  free  the 
body  from  the  products  of  intoxication,  which  may  be  stored 
up  for  two  or  three  days  and  disappear  after  one  night's  suffi- 
cient sleep. 

Too  much  sleep  may  be  nearly  as  bad  as  too  little.  After 
sleep  too  long  continued  we  feel  very  heavy  and  oppressed ;  we 
must,  therefore,  observe  the  right  medium  in  this  as  in  every- 
thing else.  The  greatest  maxim  for  longevity  is  moderation  in 
all  things. 

Granted  the  great  importance  of  sleep  as  a  function  of 
ridding  the  body  of  toxic  products  and  of  replacing  spent  energy, 


382  Old  Age  Deferred. 


it  will  be  only  too  natural  for  us  to  do  our  best  to  assure  its 
regular  performance  if  we  are  desirous  of  living  long  and  retain- 
ing the  vigor  of  youth  as  much  as  possible.  Indeed,  sleeplessness, 
if  continued  for  a  few  nights,  is  most  dangerous  in  tending  to 
produce  premature  old  age.  We  have  only  to  look  at  the  face 
of  a  person  who  has  passed  a  sleepless  night  or  nights  and  we 
shall  see  sunken  eyes,  hollow  cheeks,  and  pendant  features  which 
bear  a  strong  resemblance  to  the  face  of  an  elderly  person.  It  is 
then  interesting  to  note  how  one  night  of  sound  sleep  will  restore 
the  normal  youthful  appearance,  which  is  an  indication  of  the 
beneficial  influence  of  sleep  in  the  problem  of  senility. 

Sleepless  nights  must  be  avoided  by  every  means.  If  pos- 
sible never  travel  at  night,  unless  we  feel  assured  that  our  sleep 
on  the  train  will  not  be  disturbed ;  always,  if  we  can,  give  the 
preference  to  day  travel.  The  less  often  we  go  to  bed  after 
midnight  the  better  will  be  our  chances  for  the  retention  of  youth 
and  a  long  life. 

Going  to  bed  early  enables  us  to  rise  early;  and  this  is  a 
powerful  factor  in  long  life,  proven  by  the  fact  that  the  majority 
of  people  living  to  be  ioo  or  over  were  early  risers.  The  great 
importance  of  this  has  been  perpetuated  by  Wesley,  the  founder 
of  the  Wesleyan  Church,  in  the  familiar  verse : — 

"Early  to  bed,  and  early  to  rise, 
Makes  a  man  healthy,  wealthy,  and  wise." 

Wesley  lived  to  be  88  years  old. 

We  have  often  noticed  very  old  people  go  to  bed  after 
sunset  and  rise  with  the  earliest  dawn.  As  a  rule,  people  who 
go  to  bed  early,  some  hours  before  midnight,  enjoy  the  soundest 
sleep  because  of  the  fact  that  sleep  is  always  deepest  at  about 
midnight.  Usually  only  those  living  in  villages  can  indulge 
in  this  healthy  habit,  and  doubtless  this  is  one  of  the  reasons  for 
their  long  life  and  robust  health. 


CHAPTER   XLVIII. 
The  Treatment  of  Sleepiness  and  Insomnia. 

We  have  mentioned  in  a  previous  chapter  that  insomnia 
is  a  source  of  great  danger  to  our  prospects  for  a  continued 
youthfulness  and  a  long  life. 

Before  dealing  fully  with  this  subject  it  may  be  useful  to 
refer  to  the  treatment  of  sleepiness  also,  as  our  remarks  concern- 
ing this  will  tend  to  explain  better  the  novel  and  most  rational 
treatment  of  insomnia  which  we  here  advocate. 

We  have  already  seen  that  the  degeneration  or  removal  of 
the  thyroid  gland  produces  sleepiness,  and  its  hyperactivity 
sleeplessness,  as  in  Graves's  disease.  It  therefore  appears  ra- 
tional that  if  we  wish  to  treat  sleepiness  we  must  first  create  a  con- 
dition of  hyperactivity  in  the  thyroid  gland,  or  at  least  we  must 
improve  its  action. 

The  best  way  to  attain  this  is  to  administer  thyroid  extracts, 
which,  as  we  have  stated  before,  are  able,  according  to  our 
researches,  not  only  to  improve  sleepiness,  but  even  to  create  the 
opposite  condition — sleeplessness. 

We  have  already  referred  in  another  part  of  this  book  to 
our  observation  of  a  case  of  sleeping  sickness  in  an  officer  of 
the  Belgian  Congo  Army,  who  was  almost  always  asleep.  To 
him  we  administered  thyroid  tablets,  and  after  a  few  days 
there  was  a  marked  change  in  his  mental  attitude  and  in  his 
whole  condition,  and  the  sleepiness  improved.  But  we  ob- 
tained still  better  results  in  the  case  of  a  very  stout  man  weigh- 
ing 124  kilos,  who  was  always  falling  asleep,  so  much  so  that 
he  was  arrested  in  the  picture  gallery  at  Versailles,  where  he 
had  fallen  asleep  while  looking  at  the  pictures.  This  patient 
would  fall  asleep  when  out  walking,  and  this  occurring  in  the 
streets  of  Carlsbad,  he  was  picked  up  under  the  impression  that 

(383) 


384  Old  Age  Deferred. 


he  was  drunk,  while  in  reality  he  was  perfectly  sober.  Having 
treated  him  for  a  few  weeks  with  thyroid  tablets,  his  sleepiness 
was  much  improved,  so  much  so  that  he  did  not  fall  asleep  in 
our  waiting  room,  where  formerly  the  other  patients  would 
prevent  him  from  falling  off  his  chair  when  sleeping.  This 
gentleman  was  the  patient  of  Professor  Launois,  of  Paris,  and 
on  his  return  home  after  a  six  weeks'  treatment  we  found  that 
he  was  cured  of  his  sleepiness  and  had  lost  16  kilos  (35^ 
English  pounds). 

We  were  also  able  to  observe,  in  our  own  person,  the  ac- 
tion of  thyroid  extracts;  for,  having  for  a  few  weeks  taken 
two  tablets  daily  (about  10  grains),  we  began  to  suffer  from 
sleeplessness,  and  our  rest  did  not  again  become  natural  until 
after  we  had  discontinued  the  thyroid  treatment.  This  was  an 
experiment  that  we  made  for  our  own  personal  instruction,  and 
judging  from  the  results,  we  considered  that  they  indicated  the 
trial  of  thyroid  extracts  in  cases  of  habitual  sleepiness. 

To  treat  insomnia  we  naturally  must  first  endeavor  to 
prevent  it,  to  do  which  we  must  bear  in  mind  the  advice  ten- 
dered in  the  chapter  on  the  hygiene  of  sleep.  The  best  means 
to  insure  good  sleep  is  to  partake  of  a  light  early  supper,  and  to 
have  a  very  dark  and  quiet  room.  It  is  decidedly  unreasonable  to 
resort  to  injurious  drugs  for  sleeplessness,  instead  of  darken- 
ing the  window  and  transom  to  exclude  the  light,  and  sleeping 
in  a  room  where  no  noise  can  penetrate. 

Persons  suffering  from  sleeplessness  must,  above  all,  lead 
a  hygienic  life;  they  must  take  exercise  every  day,  walking  or 
running  in  the  open  air,  even  in  cold  weather,  so  as  to  produce 
some  fatigue  before  going  to  bed.  Sitting  the  whole  afternoon 
and  living  in  an  overheated  room  is  absolutely  inimical  to  sound 
sleep ;  but  overexercise  and  excessive  fatigue  may  also  be  as  bad. 

It  is  an  excellent  thing  for  persons,  whose  sleep  is  not  as  it 
should  be,  to  drive  in  an  automobile  or  carriage  for  an  hour,  at 
least,  before  going  to  bed,  the  former  being  preferable  owing  to 
the  greater  current  of  fresh  air.     We  often  notice  children  get- 


Treatment  of  Sleepiness  and  Insomnia.  385 

ting  drowsy  after  being  out  in  the  pure  open  air ;  and  in  places 
which  are  situated  at  a  certain  height  up  a  mountain,  we  often 
obtain  excellent  results  in  insomnia. 

Many  people  sleep  better  after  a  warm  (not  hot)  bath,  last- 
ing twenty  minutes  at  least,  just  before  going  to  bed ;  on  the 
other  hand,  a  cold  bath  might  prove  too  stimulating  and  hinder 
sleep. 

Some  people  experience  difficulty  in  falling  asleep ;  others 
easily  do  this,  but  awake  soon,  after  four  to  five  hours  of 
sound  sleep,  and  then  cannot  fall  asleep  again.  A  very  dark 
and  quiet  room  may  overcome  this  perhaps,  but  a  room  into 
which  light  enters  from  the  street  or  through  the  transom  will 
never  do  so.  When  there  has  been  no  sleep  for  a  whole  night, 
and  no  sleep  on  the  second  night  till  after  midnight,  we  may  give 
a  remedy  to  produce  sleep,  but  not  otherwise.  In  principle  we  are 
decidedly  against  the  use  of  remedies  to  induce  sleep,  and  we 
only  permit  such  after  two  partially  sleepless  nights — when  on 
the  third  night  there  is  no  sleep  until  midnight,  or  after  a  thor- 
oughly sleepless  night  when  there  is  also  no  sleep  the  following 
night  till   midnight. 

We  have  already  mentioned  that  the  effects  of  one  sleepless, 
or  several  partially  sleepless,  nights,  may  be  compensated  for  by 
one  thoroughly  good  night's  sleep.  As  through  sleeplessness 
toxic  products  are,  in  all  probability,  retained  in  the  body,  certain 
hygienic  rules  must  be  observed  after  a  sleepless  night,  thus,  for 
instance,  a  cold  room  ought  to  be  heated  before  we  get  up,  for  the 
effects  of  such  a  night  are,  according  to  our  observations,  felt 
more  when  we  get  up  in  a  cold  room  than  when  we  get  up  in  a 
well-warmed  one. 

It  will  also  be  most  beneficial  to  take  a  very  hot,  or  even  a 
Turkish  or  Russian,  bath  after  a  sleepless  night,  in  order  to  elimi- 
nate toxic  products  by  abundant  perspiration.  An  electric  light 
bath  may  give  better  results,  using  principally  the  blue  rays,  as 
such  have  a  soothing  effect  upon  the  nervous  system,  besides 
creating  a  free  sudorific  action. 

25 


386  Old  Age  Deferred. 


If  all  the  hygienic  rules  above  indicated  are  applied  and 
fail,  then  the  conditions  are  such  that  we  may  resort  to  sleeping 
remedies,  adopting,  however,  the  principle  to  try  first  the  most 
innocuous,  and  especially  such  as  the  patient  will  not  become 
addicted  to  the  use  of. 

The  principal  object  is  to  diminish  the  excitability  of  the 
brain,  and  bromide  is  one  of  the  least  dangerous  remedies  to 
obtain  this  result.  We  will  therefore  first  try  sodium  bromide, 
say,  20  grains,  in  a  glass  of  water.  Valerian  also  can  give  good 
results,  and  is  not  a  dangerous  remedy.  There  is  a  German 
preparation,  bromural,  composed  of  bromide  and  valerian,  which 
is  a  very  mild  sleeping  mixture.  Chloral  is  also  an  excellent 
drug  for  reducing  the  excitability  of  the  brain,  but  it  is  not  so 
harmless  as  the  others.  There  has,  of  recent  years,  been  intro- 
duced from  Germany  a  preparation,  isopral,  made  from  chloral, 
and  for  which  it  is  claimed  that  it  is  a  mild  sleeping  mixture  to 
the  use  of  which  people  do  not  become  addicted. 

Such  remedies  may  be  prescribed  when  there  is  only  a  tem- 
porary sleeplessness  and  not  one  of  habitual  long  standing. 
When  sleeplessness  is  more  inveterate  and  obstinate  the  above 
remedies  will  give  no  result,  and  then  stronger  drugs  must  be 
resorted  to,  such  as  veronal ;  but  this  must  never  be  given  in 
large  doses,  as  it  may  produce  in  certain  persons  symptoms 
of  intoxication  if  more  than  1  gramme  (15  grains)  be  taken. 
The  principle  of  this  remedy,  which  contains  urea,  is  to  produce 
a  condition  analogous  to  intoxication,  by  producing  fatigue. 
None  of  these  agents  should  be  used  otherwise  than  under  the 
supervision  of  a  physician. 

Some  of  our  patients  complained  of  heaviness  in  the  head 
after  the  use  of  veronal,  while  others  approved  of  it  and  found 
that  they  could  also  sleep  on  the  following  night,  even  after  only 
the  one  dose. 

It  would  be  most  injurious  to  health  to  use  these  sleeping 
mixtures  habitually,  especially  opium  and  morphine.  We  have 
mentioned  here  only  a  few  with  which  we  have  experimented  on 


Treatment  of  Sleepiness  and  Insomnia.  387 

ourselves  or  tried  on  patients  in  cases  of  necessity,  as  all  such 
remedies  may  be  injurious  to  the  brain  if  taken  often. 

We  feel  inclined  to  attribute  greater  importance  to  a  sleep- 
ing remedy  which  is  based  on  physiological  observations  of  sleep. 
As  we  have  already  stated,  thyroid  degeneration  or  removal 
produces  sleepiness;  we  have,  therefore,  tried  the  serum  of 
animals  whose  thyroid  has  been  extirpated,  and,  as  will  be  proved, 
we  have  had  good  results  in  each  case. 

Being  struck  by  the  similarity  of  the  symptoms  of  dia- 
betes to  those  of  Graves's  disease,  and  as  a  logical  consequence 
of  our  researches  on  the  frequency  of  a  hyperactivity  of  the  thy- 
roid in  diabetes,  we  tried  a  remedy  for  this  condition  which 
has  produced  as  good  results  as  many  authorities  have  obtained  in 
their  treatment  of  Graves's  disease.  This  is  the  serum  of  goats 
from  which  the  thyroid  has  been  removed,  prepared  according  to 
the  formula  of  the  celebrated  neurologist,  Dr.  Moebius,  of  Leipzig, 
who  died  recently.  This  remedy,  named  after  its  discoverer 
"anti-thyroidin  Moebius,"  has  not  only  afforded  us  good 
results  in  the  diminution  of  glycosuria,  as  we  showed  by  a  number 
of  cases  in  the  book  that  we  published  upon  the  origin  of  diabetes, 
but  also,  what  is  still  more  interesting  to  our  present  subject, 
every  patient  suffering  from  insomnia  exhibited  an  improvement ; 
in  fact,  there  was  not  a  single  case  which  did  not  benefit  by  this 
treatment.1 

Following  an  automobile  accident  we  suffered  much  from 
insomnia.  We  tried  this  remedy  personally,  and  after  doses  of 
5  grammes  (75  grains)  we  were  each  time  able  to  sleep  for 
about  eight  hours,  and  felt  refreshed  afterward.  We  have  found 
this  remedy  superior  even  to  veronal,  for  the  latter,  when  tried 
personally  and  afterward  in  patients,  did  not  give  the  same  effect 
as  anti-thyroidin. 

This  remedy  has,  however,  one  great  drawback,  and  that 
is  the  exorbitant  cost;  and  it  requires  to  be  taken  in  considerable 
amounts,  at  least  45  to  70  grains  at  a  dose,  although  in  some 

1  Loc.  cit. 


Old  Age  Deferred. 


patients  a  soothing  result  has  been  obtained   from   20   grains 
three  times  a  day. 

This  drug  diminishes  the  excitability  of  the  nervous  sys- 
tem, and  is,  therefore,  an  excellent  remedy  for  insomnia, 
for  it  depends  on  a  physiological  appreciation  of  our  knowl- 
edge of  the  influence  of  the  thyroid  gland  on  sleep.  We  have 
lately  published  an  article  on  the  hypnotic  effect  of  anti-thyroidin 
Moebius  in  the  "Therapie  der  Gegenwart"  of  Berlin,  Novem- 
ber,  1907. 

Instead  of  the  anti-thyroidin  Moebius — the  extravagant 
price  of  which  forbids  its  general  use — we  would  recommend 
extirpating  the  thyroid  gland  of  a  goat,  which  is  a  very  simple 
operation,  and  making  use  of  the  milk,  following  the  example  of 
Professor  Lanz,  of  Amsterdam,  and  of  Walter  Edmunds  in 
London. 

Our  observations  on  the  great  influence  of  anti-thyroidin 
on  sleep  were  confirmed  by  Professor  Lanz  in  a  discussion 
following  an  address  we  delivered  before  the  Society  for  the  Ad- 
vancement of  the  Medical  and  Natural  Sciences,  in  Amsterdam, 
on  the  15th  of  March,  1905.2  He  also  mentioned  the  case  of  a 
dog  whose  master,  a  peasant,  was  tending  the  professor's  goats, 
whose  thyroids  had  been  removed  and  whose  milk  was  being 
administered  by  the  professor  to  his  patients  suffering  from 
Graves's  disease.  The  peasant  was  told  to  give  the  goats' 
milk  to  his  dog,  but  after  a  time,  the  peasant  refused  to  do  this, 
as  since  the  goats'  milk  had  been  given  to  the  dog,  he  always 
wanted  to  go  to  sleep,  even  when  accompanying  his  master  in 
his   walks. 


2  Nederlandsch  Tijdschrift  voor  Geneeskunde,  1905. 


CHAPTER   XLIX. 

Hygiene  of  the  Sexual  Glands — the  Dangers  of  Sexual 
Overactivity  and  of  Total  Sexual  Abstinence. 

We  have  referred,  in  previous  chapters  of  this  work,  to  the 
great  influence  of  the  sexual  glands  on  several  of  the  most  im- 
portant organs,  and  shown  in  what  a  marvelous  way  these 
glands  affect  our  vitality  and  prospects  of  longevity  (see  Chap- 
ter V)  ;  consequently  it  is  only  natural  that  we  should  use  our 
best  endeavors  to  maintain  these  glands  in  good  working  con- 
dition, which  we  can  do  in  a  rational  manner  by  protecting 
them  from  all  harmful  agencies,  which  may  be  numerous.  It 
would  exceed  the  limits  of  this  book  to  enumerate  all  the  dif- 
ferent causes  of  diseases  of  the  sexual  glands,  so  we  will  con- 
fine ourselves  to  the  most  frequent,  which,  although  not  imme- 
diately producing  actual  disorders  of  the  glands,  may  yet  lower 
their  vitality  in  the  long  run  and  finally  lead  to  their  degen- 
eration. 

The  infectious  diseases  of  the  sexual  glands,  acquired  by 
contagion  through  sexual  intercourse,  occupy  a  prominent  place 
among  the  agencies  deleterious  to  them.  They  are  well  dealt 
with  in  the  handbooks  on  this  subject,  so  will  not  be  further 
referred  to  here.  The  best  way  to  avoid  them  is  by  marriage. 
This  may,  in  the  majority  of  cases,  be  a  safeguard  for  the 
man  but  not  for  the  woman;  for,  unhappily,  in  very  many  in- 
stances women  are  infected  by  their  husbands  as  soon  as  they 
enter  the  bonds  of  matrimony. 

In  Chapter  VII  we  mentioned  the  injurious  consequences 
of  these  infections,  not  only  for  men,  but  also  for  women,  and  told 
how  in  the  former  sexual  potency,  and  in  the  latter  fertility,  may 
be  ruined  by  such.  The  best  way  to  deal  with  the  matter  would 
be  to  pass  a  law  enforcing  the  examination  of  the  prospective 

(389) 


390  Old  Age  Deferred. 


husband  by  a  physician;  and  if  such  a  law  were  applied  also 
to  the  woman,  the  propagation  of  certain  hereditary  dis- 
eases might  be  arrested.  Long  ago  Plato  thought  of  such  an 
emergency.  He  recommended  that  before  a  marriage  judges 
should  examine  both  man  and  woman,  the  man  to  be  stark 
naked,  and  the  woman  partially  so ;  after  the  inspection  the 
judges  were  to  deliver  their  opinion  whether  the  couple  should 
be  married  or  not. 

Nearly  as  injurious  as  infectious  diseases  may  be  the  abuse 
of  the  sexual  glands  by  too  frequent  intercourse,  by  masturba- 
tion, or  by  other  irritations  of  these  glands,  such  as  excitation, 
without  subsequent  satisfaction,  especially  in  cases  of  interrupted 
copulation  with  a  view  to  avoid  offspring. 

Too  frequent  sexual  intercourse  may  soon  sap  the  vitality 
of  these  glands  and,  indeed,  hasten  the  symptoms  of  old  age, 
even  in  young  persons.  As  already  mentioned,  even  young  girls 
may  acquire  some  of  the  attributes  of  old  age  by  such  means. 
They  soon  become  fat  and  bloated,  the  features  lose  their  juvenile 
aspect,  and  the  cheeks  become  pendant ;  the  muscles  lose  their 
tonicity,  and  there  is  a  marked  difference  between  the  muscles 
of  a  young  maiden  and  those  of  a  woman  of  the  same  age  who 
has  been  leading  a  life  of  debauchery  for  some  time.  The  latter 
will  invariably,  if  not  always,  look  older — which  ought  to  be  an 
object  lesson  on  this  subject.  Premature  old  age  can  similarly 
be  brought  about  by  constant  conditions  of  exhaustion  of  the 
ovaries  consequent  to  frequent  pregnancies.  When  a  woman  has 
a  child  year  after  year,  as  a  rule,  especially  if  living  in  straitened 
circumstances,  she  usually  looks  older;  but  this  is  not  SO'  in  all 
cases,  as  we  have  before  remarked. 

Moderation,  therefore,  must  be  strictly  observed. 

The  ancient  Hindoos  recommended  to  men  sexual  absti- 
nence of  long  duration,  thinking  that  by  this  means  the  internal 
secretion  of  the  sexual  glands  would  be  absorbed  into  the  system 
and  that  they  would  thereby  reap  all  the  benefits  inherent  in 
such  a  secretion.     By  this  it  seems  that  thousands  of  years  before 


Hygiene  of  the  Sexual  Glands.  391 

Claude  Bernard  and  Brown-Sequard  the  Hindoos  already  ap- 
preciated the  great  importance  of  the  internal  secretions. 

According  to  the  Prophet  Mohamed,  sexual  intercourse 
should  not  be  more  frequent  than  once  in  eight  days.  Zoroaster 
recommends  once  in  nine,  Solon  and  Socrates  once  in  ten,  and 
Moses  eight  days  before  and  eight  days  after  menstruation,  and 
Luther  twice  a  week  (der  Woche  Zwie).  The  Holy  Book  of 
the  Jews,  The  Talmud,1  an  encyclopaedia  of  Jewish  knowledge 
embracing  a  period  of  from  500  years  before  to  500  years  after 
Christ,  recommends  the  following  in  respect  to  marital  inter- 
course :  Young  strong  men,  every  day ;  workmen,  once  a  week ; 
mental  workers,  once  a  month.  Acton  advises  copulation  once 
only  in  from  seven  to  ten  days.2 

Pomeroy  says  matrimony  is  Nature's  nectar,  but  if  we 
indulge  too  freely,  instead  of  nectar  Nature  will  offer  us  water 
or  bile,  and  finally  deadly  poison.  To  avoid  sexual  overactivity 
ill  married  people  Kisch  recommends  a  separate  bed  for  man  and 
wife. 

Far  more  dangerous  than  too  frequent  intercourse  are  fre- 
quent excitations  of  the  sexual  organs  without  final  sexual  satis- 
faction. In  this  way  a  continual  hypersemia  of  the  caput  galli- 
naginis  in  the  prostate  can  be  set  up ;  and  as  this  is  where  the 
ducts  of  the  seminal  vesicles  end,  premature  emissions  and  impo- 
tency  may  result.  Thus  we  see  that  masturbation  and  inter- 
rupted copulation  may  produce  the  same  effect;  indeed,  these 
practices  are  far  more  injurious  to  virility  than  sexual  over- 
activity if  indulged  in  in  the  normal  way. 

Frequent  sexual  excitations  are  also  very  deleterious  to  the 
female  sexual  organs,  which  are  thereby  brought  into  a  hyper- 
semic  condition ;  and  if  this  dangerous  practice  be  often  repeated 
serious  disorders  may  follow,  and  especially  is  this  the  case  if 
intercourse  be  interrupted  before  the  seminal  emission. 


1  Quoted  after   Prof.   Kisch   "Das   Geschlechtsleben   des   Weibes,"   Vienna, 
second  edition,  1908. 

2  Quoted  after  Prof.  Kisch,  as  are  most  of  the  quotations  in  this  chapter. 


392  Old  Age  Deferred. 


According  to  Professor  Kish  such  preventive  coition  (con- 
gressus  interruptns)  may  be  followed  by  a  relaxation  of  the 
uterus  and  chronic  metritis.  The  hypersemia  and  stagnation  of 
the  blood  may  lead  to  inflammation  of  the  ovaries  and  parame- 
tritis, and  perhaps  to  new  growths.  Neugebauer  and  Pigeolet 
have  often  observed  cancer  of  the  uterus  in  women  who  made 
a  habit  of  indulging  in  sexual  intercourse  with  the  use  of  pre- 
ventives against  conception.  Metritis  and  parametritis  after 
such  a  proceeding  have  been  observed  by  Bircher,  Valente,  etc. 

Certain  abuses  of  the  female  sexual  organs,  such  as  copula- 
tion during  menstruation,  may  also  be  ruinous  to  those  organs; 
metritis,  parametritis,  ovarian  inflammation,  etc.,  may  be  the 
result  of  such  grave  violations  of  this  most  elementary  rule  of 
the  hygiene  of  the  sexual  glands. 

The  ancient  Mosaic  Laws  prescribed  the  punishment  of 
death  for  intercourse  during  menstruation.  During  this  period 
all  kind  of  work  should  be  prohibited,  and  for  many  women  it 
would  be  wisest  to  rest  completely,  especially  during  the  first 
day. 

Women  should  not  marry  under  a  certain  age,  preferably 
not  under  20.  With  the  Spartans  no  man  was  allowed  to  marry 
before  30,  and  no  woman  before  20,  and  we  know  what  a  robust 
and  strong  nation  they  were.  This  is  most  essential  to  avoid 
premature  senility,  which  can  easily  develop  in  women  who  com- 
mence sexual  intercourse  at  an  early  age.  No  woman  should  be 
permitted  to  marry  until  she  is  fully  developed  physically  and 
mentally.  There  are  cases  where  women  are  not  fully  developed 
at  18,  or  even  at  20,  and  in  such  cases  marriage  should  be 
deferred  to  a  later  period. 

Close  observation  of  the  rules  for  a  rational  hygiene  of  the 
sexual  organs  also  demands  that  chlorotic  girls  should  not  marry 
until  their  condition  is  improved  by  iron  treatment,  the  sexual 
organs  in  cases  of  severe  chlorosis  or  anaemia  not  being  fit  for 
use. 

We  have  referred  to  the  dangers  of  sexual  overactivity,  and 


Hygiene  of  the  Sexual  Glands.  393 

we  will  now  endeavor  to  show  that  the  opposite  extreme,  viz., 
complete  inactivity  of  these  glands,  may  also  lead  to  disastrous 
consequences.  When  nature  created  our  different  organs  they 
were  intended  to  be  used,  and  there  is  no  part  and  no  organ  in  the 
body  that  should  not  fulfil  its  function  (even  the  appendix,  as 
lymphatic  tissue,  has  one).  No  exception  can  be  made  in  favor 
of  the  sexual  organs,  although  the  hypocrisy  of  certain  faddists 
would  have  us  believe  that  these  organs  alone  out  of  the  whole 
body  should  serve  no  purpose  whatever.  Indeed,  the  whole 
anatomical  construction  and  the  physiological  working  of  these 
organs — differing  in  each  sex — shows  that  Nature  intended  them 
to  be  used  in  conjunction  with  each  other. 

These  organs  are  glandular  formations  having,  like  all 
other  glands  of  the  body,  a  secretion,  which,  like  the  secretions  of 
the  other  ductless  glands — as,  for  example,  the  thyroid — if  pro- 
duced in  too  large  quantities,  may  have  toxic  effects.  That  this 
really  is  the  case  is  shown  by  the  experiments  of  Loisel,  who 
found  that  the  extracts  from  the  testicles,  and  still  more  so  from 
the  ovaries,  if  injected  into  other  animals,  have  toxic  effects. 

The  sexual  glands,  being  glands  with  an  epithelial  formation, 
must  certainly  produce  a  secretion;  they  could  not  be  an 
exception  to  one  of  the  fundamental  laws  of  anatomy  and  his- 
tology. The  accumulation  of  this  secretion  may  produce  certain 
toxic  effects,  judging  from  the  experiments  of  Loisel.2a  We 
may,  therefore,  conclude  that  the  complete  inactivity  of  these 
glands  or,  in  other  words,  total  sexual  abstinence,  may  have  inju- 
rious effects  on  the  general  health,  as  also  on  the  condition 
of  the  glands  themselves;  and  we  are  able,  by  experiments 
and  clinical  and  anatomo-pathological  observations,  to  confirm 
this  view. 

Regaud3  has  observed  that  when  guinea  pigs  are  kept  for 
a  long  time  in  complete  sexual  abstinence,  away  from  their 
females,  the  testicles  present  degenerative  changes,  and  at  the 


2a  Loisel:     Journal  de  1'Anat.,  xi,  p.  536;    C.  R.  S.  B.,  L.  ix,  p.  403. 

3  Regaud:     Comptes  rendus  de  1'Association  des  Anatomistes  p.  198,  1903. 


394  Old  Age  Deferred. 


same  time  the  volume  of  the  gland  is  considerably  diminished. 
The  seminal  epithelium  shows  many  cells  with  signs  of  degenera- 
tion. He  also  observed  similar  signs  in  the  epithelium  of  the 
seminiferous  tubules  during  winter  hibernation,  and  also  in  the 
spring  when  the  animals  were  not  sleeping  but  if  they  were  kept 
in  total  sexual  abstinence.  Although  they  were  well  nourished 
these  animals  showed  no  spermatogenesis. 

Regaud  comes  to  the  conclusion  that  "la  continence  forcee 
peut  done  avoir  pour  consequence  des  modifications  importantes 
de  l'epithelium  seminal" — enforced  abstinence  (sexual)  may 
thus  lead  consequently  to  important  modifications  of  the  seminal 
epithelium. 

According  to  Mingazzini,4  the  ovaries  of  female  animals  that 
are  kept  in  captivity  and  sexual  abstinence  present  degenerated 
follicles,  this  being  very  different  to  the  ovaries  of  other  females 
living  in  freedom,  the  comparisons  having  been  made  in  the  same 
season  of  the  year. 

There  is  some  evidence  to  show  that  similar  results  may 
happen  in  man.  When  men  live  a  long  time — not  for  weeks 
or  a  few  months,  but  for  a  very  lengthened  period — in  total 
sexual  abstinence,  the  size  of  the  testicles  may  sometimes  be 
found  diminished.  Unfortunately  there  have  not  as  yet  been 
made,  at  least  to  our  knowledge,  histological  examinations  of 
the  sexual  glands  of  those  who  really  have  led  a  life  of  total 
sexual  abstinence.  But  a  remote  proof  in  support  of  our  propo- 
sition that  such  a  condition  may  lead  to  histological  changes  in 
these  important  glands,  is  the  fact  that  Baldwin  has  discovered 
histological  changes  in  the  ovaries  of  hysterical  women,  of 
whom  a  large  proportion  were  either  spinsters  or  women  who 
became  widows  early  in  life.  Of  course  this  is  but  a  very 
indirect  proof,  devoid  of  the  scientific  value  of  the  observations 
of  Regaud  and  Mingazzini. 

There  are,  however,  important  clinical  facts  which  support 


4  Mingazzini:      Corpi  lutes  veri  e  falsi;    E.  F.  Laboratorio  di  Anatomia 
normale  clella  Reale  Universita  di  Roma,  vol.  iii,  1893. 


Hygiene  of  the  Sexual  Glands.  80S 


the  supposition  that  total  sexual  abstinence  may  lead  to  alteration 
of  these  glands.  Thus  we  have  observed  impotence  in  the  cases 
of  several  men  after  sexual  abstinence  of  long-  duration,  which 
entirely  disappeared  in  nearly  every  case  after  copulation 
at  regular  intervals;  and  we  arrive  at  the  conclusion  that  a 
regular  use  of  these  organs,  which  are  intended  by  Xature  to  be 
used,  is  a  necessity,  and  that  impotence  can  frequently  be  best 
cured  by  marriage.  In  marriage  only  can  hygienic  and  regular 
sexual  intercourse  best  take  place ;  and  thus  marriage  is  the  best 
hygiene  for  the  sexual  glands.  For  this  and  other  important 
reasons  we  will  devote  a  special  chapter  on  marriage,  which  will 
succeed  this.  In  some  maidens  near  the  thirties  we  can  note  the 
appearance  of  symptoms  of  fading;  through  the  loss  of  fatty 
tissue  those  parts  of  the  body  that  were  formerly  round  become 
angular,  and  there  thus  develops  the  condition  of  leanness  so 
typical  of  old  spinsters;  hairs  may  also  appear  on  the  chin  and 
upper  lip.  That  all  this  is  caused  by  the  inactivity  of  the  sexual 
glands,  which,  as  already  explained,  influence  the  outward 
appearance  of  the  body,  is  best  demonstrated  by  the  fact  that 
after  marriage  a  great  change  takes  place  in  such  women,  and 
the  fading  rose-tree  blooms  again.  Thus  marriage  re-creates 
youth. 

The  deleterious  effects  of  total  sexual  abstinence  on  the 
sexual  glands  have  also  been  observed.  Professor  Kisch  noted 
that  with  women  who  had  lived  an  active  sexual  life  and  who 
had  had  several  children,  whom  they  had  fed  from  the  breast, 
menstruation  continued  till  a  later  period  in  life  than  it  did  in  old 
maids,  or  in  women  who  early  in  life  had  become  widows,  or  in 
barren  women. 

That  total  sexual  abstinence  may  have  very  injurious  effects 
on  the  nervous  system,  as  mentioned  in  Chapter  IV,  and 
assist  in  the  development  of  hysteria  and  neurasthenia,  is  shown 
by  the  fact  that  when  there  is  an  accumulation  of  semen  in  the 
male,  or  a  swelling  of  the  Graafian  follicles  in  the  female,  then 
an  excitation  of  the  nervous  system  follows,  with  sexual  desire. 


396  Old  Age  Deferred. 


That  the  nervous  system  can  be  excited  and  even  seriously  dam- 
aged by  too  frequent  and  too  excessive  impulses  conveyed  from 
the  sexual  glands,  has  been  mentioned  by  us  at  various  times 
in  this  book. 

The  continual  resistance  to  satisfy  sexual  desire,  and  espe- 
cially satisfaction  by  artificial  means,  may  lead  to  ruinous  conse- 
quences for  the  nervous  system  and  the  sexual  glands. 

Happily  there  can  be  no  doubt  that  many  men  and  women 
lead  healthy  lives,  in  spite  of  their  struggles  against  satisfying 
the  desire  of  the  sexual  organs  to  follow  their  natural  bent;  but 
such  cases  are  not  the  rule,  and  most  of  such  people  have  some 
kind  of  disorder,  especially  of  the  nervous  system  or  the  digestive 
organs,  as,  for  instance,  cardialgia,  or  acidity  of  the  stomach. 
We  have  already  referred  to  the  alteration  in  these  organs 
following  changes  in  the  sexual  organs. 

There  are  people  with  a  frigid  disposition, — which  is  cer- 
tainly not  normal — and  such  may  not  be  troubled  by  their  sexual 
glands.  On  the  other  hand,  there  are  people  with  too  great  a 
sexual  inclination.  The  suppression  of  these  desires  in  them  may 
often  lead  to  ruin  of  the  nervous  system.  Prof.  Krafft-Ebing 
found  that  individuals  with  neuropathic  constitutions  often  have 
their  desires  exaggerated  in  a  pathological  way,  and  he  came  to 
the  conclusion  that  in  such  persons,  through  enforced  sexual 
abstinences,  the  nervous  system  may  be  ruined.  Professor  Erb, 
the  famous  Heidelberg  specialist  for  nervous  diseases,  declared  at 
the  Congress  of  the  German  Society  for  the  Suppression  of 
Vice,  held  a  few  years  ago  at  Frankfort,  that  there  are  adult 
individuals  in  whom  sexual  abstinence  for  a  long  time  produces 
serious  mischief  in  the  nervous  system. 

Buddha  says :  "Sexual  instinct  is  stronger  than  the  iron 
hook  with  which  wild  elephants  are  tamed ;  it  is  hotter  than 
fire ;    it  is  an  arrow  that  pierces  the  soul  of  man." 

Martin  Luther  says :  "He  who  wants  to  hinder  sexual  in- 
stinct, and  does  not  let  Nature  go  as  Nature  wants  and  must, 
is   doing  as   if  he  were   trying  to   hinder  Nature   from  being 


Hygiene  of  the  Sexual  Glands.  397 

Nature ;  that  fire  should  not  burn  ;  that  water  should  not  make  us 
wet;  that  man  should  not  eat,  drink,  nor  sleep." 

One  of  the  pioneers  of  the  movement  in  Germany  for  the 
emancipation  of  women — Johanna  Elberskirchen — demands  free 
scope  for  the  sexual  feelings  of  women  and  their  satisfaction 
within  physiological  limits  and  according  to  physiological 
necessity. 

We  are  of  the  opinion  that,  as  a  rule,  there  is  a  certain  dif- 
ference between  sexual  desire  in  man  and  the  same  in  woman. 
Man  mostly  wants  satisfaction  simply ;  in  women  there  is  gen- 
erally a  higher  motive :  she  demands  love,  and  refuses  satis- 
faction alone. 

Nature,  who  has  created  the  sexual  organs  of  male  and 
female  as  a  masterpiece  of  very  clever  and  skilful  construction, 
with  admirable  forethought  in  even  the  smallest  details  of  this 
very  complicated  mechanism,  has  appointed  to  them  a  very  im- 
portant purpose,  viz.,  the  propagation  of  the  race ;  and  she  pur- 
sues her  ends  in  a  most  artful  way,  giving  to  each  sex  certain 
attributes  by  which  the  opposite  may  be  attracted.  The  peacock, 
for  instance,  is  furnished  with  a  wonderful  collection  of  beautiful 
feathers  to  excite  the  sexual  feelings  of  the  hen,  which  has  a 
much  plainer  exterior.  In  man  the  relations  are  reversed ;  here 
beauty  is  more  conspicuous  in  the  female,  and  it  is  by  their 
charms,  the  attributes  of  their  sex,  that  men  are  attracted, — who, 
unfortunately,  look  rather  to  the  beauty  of  the  outside,  which 
is  transient,  than  to  that  of  the  soul,  which  is  eternal. 

This  book  is  a  plea  for  a  simple  and  natural  life,  and  for 
obedience  to  the  laws  of  Nature  rather  than  for  neglect  or 
abuse  of  them.  Sexual  desires  are  the  outcome  of  the  existence 
of  the  sexual  glands,  and  they  are  enforced  upon  us  in  a  way 
that  is  sometimes  nearly  irresistible  after  long  continued  sexual 
abstinence.  Disobedience  to  the  imperious  commands  of  Nature 
will  draw  down  upon  us  her  revenge  and  punishment,  and  ail- 
ments and  disease,  and  bodily  and  mental  misery,  may  be  the 
consequences  of  the  complete  suppression  of  the  functions  of 


398  Old  Age  Deferred. 


these  glands  in  adults.  There  may  be  exceptions,  and  certain 
women  or  men  may  pass  a  lifetime  in  such  an  unnatural  way 
without  any  apparent  ill  consequences  to  their  health;  but  such- 
are  rare.  It  has  been  observed  not  infrequently  that  spinsters 
were  fast  fading  when  they  were  married,  but  that  after  a  time 
they  looked  much  younger,  especially  after  their  first  child.  As 
already  quoted  above  from  Kisch,  sexual  life  and,  therefore, 
youth  are  longer  preserved  in  women  who  use  their  sexual  glands 
and  have  children  than  in  those  who  do  not.  Thus  there  is  no 
alternative,  and  marriage  is  the  safest  course.  Marriage,  if  the 
partners  are  well  suited,  is  indeed  the  most  useful  and  beneficial 
institution  there  is ;  and,  as  we  will  show  in  the  next  chapter,  it  is 
one  of  the  most  important  agencies  in  the  treatment  of  old  age, 
and  for  the  longest  possible  conservation  of  youth. 

But  the  question  now  arises,  what  should  those  do  who 
cannot  get  married,  not  through  any  fault  of  their  own,  if  they 
should  escape  all  the  mischief  due  to  an  unnatural  suppression  of 
the  sexual  functions  or  their  satisfaction  in  an  unnatural  way? 
We  will  now  endeavor  to  give  a  few  useful  hints  on  the  subject. 

First  of  all,  a  hypersemic  condition  of  the  sexual  organs 
should  be  avoided  by  all  means,  and  care  should  especially  be 
taken  to  have  the  bowels  opened  every  day,  as  otherwise  hyper- 
emia of  the  pelvic  organs  will  follow.  This  may  also  be  a 
consequence  of  rich  food  and  a  sedentary  life,  which,  therefore, 
should  be  avoided.  Cold  hydrotherapeutic  washings  of  the  sur- 
face of  the  body,  particularly  of  the  sexual  parts,  may  also^  be 
beneficial.  As  during  long  sexual  abstinence  the  probability  is 
that  toxic  products  are  being  evolved  and  are  accumulating  in  the 
system,  a  good  purge  every  five  or  six  days  would  seem  to  be  a 
necessity,  as  also  would  a  hot  bath.  Reading  light  literature 
should  be  avoided.  We  especially  recommend  much  exercise  in 
the  open  air  and  sunshine,  long  walks,  mountain  climbing,  sports, 
long  journeys  (especially  by  automobile),  etc. 

The  best  safeguard  against  sexual  desires  is  an  active  busy 
life,  which  affords  no  opportunity  for  idle  thoughts. 


Hygiene  of  the  Sexual  Glands.  399 

For  persons  doomed,  from  one  cause  or  another,  to  lead  a 
life  of  complete  sexual  abstinence,  the  best  and  safest  course  to 
prevent  sexual  desire  is  to  lead  a  strenuous  business  life,  drown- 
ing the  desires  in  a  flood  of  useful  and  busy  occupations. 

Thus  unmarried  girls  and  widows  may  well  pass  their  time 
in  charity,  nursing  the  sick,  and  other  occupations  tending  to 
make  them  useful,  rather  than  spend  their  time  in  fruitless 
dreams;  and  by  such  occupations  they  obtain  a  happiness  which 
they  might  not  have  found,  perhaps,  even  in  married  life. 

The  surest  kind  of  occupation  for  the  prevention  of  the 
above  mentioned  desires  is  strenuous  mental  work.  When  the 
mind  is  busy  with  serious  problems  these  desires  cannot  obtrude 
themselves ;  and,  indeed,  we  have  often  observed  in  persons  whose 
lives  have  been  devoted  to  serious  scientific  work,  which  has 
entirely  absorbed  them,  a  total  absence  of  sexual  desire  for  a 
long  time,  and  even  impotency.  This,  however,  we  will  con- 
sider later  as  a  consequence  of  defective  hygiene  during  mental 
labor  (see  Chapter  L,  on  the  hygiene  of  the  brain  worker). 

We  do  not  recommend  mental  work  so  exaggerated  beyond 
the  ordinary  limits  that  it  might  cause  harm  to  the  brain  and 
nervous  system ;  but  it  is  certain  that  when  mental  work  is  done 
within  reasonable  limits,  and  when  it  occupies  the  greater  part 
of  our  time,  but  not  all,  it  is  a  great  protection  against  sexual 
desires,  restricting  them  without  any  injury  to  the  functions 
of  the  sexual  glands. 

Thus,  as  we  see,  there  are  certain  remedies  against  sexual 
desires  for  those  that  cannot  satisfy  them;  but  the  most  natural 
solution  of  this  question  can  be  brought  about  in  the  safest  way 
by  marriage. 


CHAPTER  L. 

On  Married  Life  as  an  Important  Means  for  Prolonging 

Life. 

Opinions  differ  as  to  whether  married  life  can  be  gener- 
ally considered  as  a  source  of  happiness ;  some  there  are  who  say 
it  is  the  acme  of  happiness,  while  others  do  not  agree  that  it  is 
exactly  a  heaven  on  earth. 

Personally  we  possess  positive  evidence  in  favor  of  the  view 
that  marriage  can  make  people  very  happy;  for  we  know  of  a 
number  of  cases  of  suicide  following  the  loss  of  husband  or  wife, 
and  we  have  a  clear  recollection  of  seeing  many  widows  or  wid- 
owers break  down  at  the  mere  mention  of  their  departed,  years 
after  the  bond  of  matrimony  had  been  thus  severed. 

Certainly  agencies  that  can  make  people  happy,  such  as 
marriage,  ought  to  be  able  to  lengthen  existence  and  remove 
petty  cares,  worry,  and  sorrow  that  are  so  prevalent  in  this  life, 
and  which,  in  the  long  run,  tend  to  induce  premature  old  age. 
As  the  Germans  say,  "Getheiltes  Leid  ist  halbes  Leid"  ("a  sorrow 
shared  is  but  half  a  sorrow"),  and  the  man  who  can  share  his 
misfortunes  with  a  beloved  wife  does  not  carry  his  burden  alone. 

This  is  of  the  greatest  importance,  for,  as  we  shall  show  in 
the  next  chapter,  the  body  is  governed  by  the  mind,  and  thus 
mental  emotions  of  a  depressing  nature  assist  in  the  development 
of  disease  and  the  symptoms  of  premature  old  age,  in  combating 
which  a  single  man  is  always  at  a  great  disadvantage. 

We  shall  also  show  that,  as  a  rule,  our  mishaps  and  disap- 
pointments are  due  to  our  own  fault  of  omission  or  commission, 
to  want  of  foresight,  etc.  It  is  a  positive  fact  that  many  a  man, 
famous  in  history,  owed  his  position  and  success  to  the  advice 
and  assistance  of  a  clever  and  sympathetic  better  half ;  this  term 
is,  indeed,  not  devoid  of  foundation,  for  a  man  does  not  so  seldom 
(400) 


Married  Life  as  Means  for  Prolonging  Life.  401 

become  perfect  through  his  better  half,  the  woman.  The  female 
character  is  so  essentially  different  to  the  male,  because  of  her 
different  anatomical  and  physiological  constitution,  that  by  the 
uniting  of  the  female  to  the  male  some  deficiency  in  the  char- 
acter in  the  latter  may  be  supplied,  and  vice  versa,  with  equal 
benefit  to  both.  Thus  the  uniting  of  the  woman  to  the  man  is 
most  desirable,  if  only  for  this  reason. 

It  would  lead  us  too  far  to  insist  on  the  enormous  advan- 
tage of  married  life  for  public  morality,  for  the  prevention  and 
repression  of  crime,  and  even  for  the  welfare  of  the  State,  the 
soundest  foundation  of  which  is  family  life.  Each  family  is  a 
little  community  in  itself,  with  the  father  at  the  head  as  king,  and 
the  mother  as  queen.  And  as  the  State  wants  subjects,  so  the 
family  wants  children ;  for  the  great  pleasures  connected  with  the 
various  stages  of  a  child's  growth  from  the  cradle  to  the  altar, 
serve  as  the  key  to  a  lengthened  and  the  longest  possible  existence. 
Cornaro  gives  us  a  very  instructive  example  in  his  saying  "in 
the  society  of  the  young  we  become  young  again ;"  and  so  chil- 
dren restore  youth. 

Not  only  because  of  the  favorable  mental  influence  exer- 
cised by  marriage  must  this  be  recommended  as  one  of  the  most 
efficient  means  for  attaining  a  long  life,  but  also  because  of  vari- 
ous other  advantages  induced  by  the  improved  hygienic  condi- 
tions of  various  organs.  Thus,  marriage  is  able  to  satisfy  the 
sexual  desires, — the  complete  suppression  of  which  is  so  injurious 
to  most  healthy  men  and  women, — without  there  being  any  risk 
of  contracting  diseases  of  the  sexual  organs  with  their  terrible 
consequences.  For  this  reason  alone  married  persons  have  the 
best  chances  for  preserving  their  youth,  provided  they  exercise 
moderation  and  do  not  indulge  in  the  pleasures  of  matrimonial 
life  beyond  the  physiological  limits. 

It  is  much  easier  to  observe  the  rules  of  hygiene  for  the 
various  organs ,  as  outlined  previously,  in  married  than  in  single 
life ;  for  in  the  latter  condition  one  is  concerned  for  himself  alone, 
whereas  in  the  former,  four  eyes  instead  of  two  are  on  the  watch. 

26 


402  Old  Age  Deferred. 


Thus  the  first  symptoms  of  disease  are  often  visible  to  the  eyes 
of  a  loving  wife,  and,  as  prevention  is  better  than  cure,  such  a 
disease  may  then  be  checked  by  promptly  applied  treatment.  Most 
diseases  could  be  cured  if  treatment  could  be  administered  at 
the  very  beginning,  whereas  curable  diseases  often  terminate 
fatally  from  neglect  of  a  sufncienctly  early  treatment.  There  can 
be  no  doubt  about  it,  but  that  as  a  rule,  a  married  man  is  far 
better  nursed,  in  case  of  sickness,  than  is  a  single  man;  and  we 
all  know  that  a  good  nurse  can  often  do  just  as  much  good, 
sometimes  even  more,  than  the  most  skilful  physician.  It  is 
certain  that  the  therapeutic  results  in  the  English  and  American 
hospitals  would  be  inferior  to  those  obtained  at  present  if  there 
were  not  such  excellent  nurses,  of  whom  these  countries  may 
indeed  well  be  proud.  Marriage,  through  the  regular  habits  it 
causes,  can  also  favorably  influence  certain  chronic  diseases ;  thus, 
according  to  Renon,  even  heart  affections  can  be  favorably 
influenced  by  married  life. 

As  a  rule  married  life  also  implies  the  possession  of  a  home, 
whereas  a  single  man  or  woman  most  often  have  no  real  home. 
They  are  obliged  to  frequent  restaurants  for  their  meals,  where 
there  is  great  likelihood  of  their  damaging  their  stomach  or  in- 
testines by  irregularities  in  food  or  drink — at  least  in  the  case  of 
men,  who  also  have  no  reason  to  stay  indoors  in  the  evening,  and 
are  thus  more  exposed  to  the  life-shortening  influences  of  an 
irregular  life. 

As  we  have  already  seen,  the  best  means  for  attaining  a 
very  long  life  is  moderation  in  everything ;  and  there  is  no  doubt 
that  this  can  be  much  better  observed  in  married  than  in  single 
life. 

For  all  the  foregoing  reasons  we  must  emphatically  advise 
all  who  desire  long  life  and  the  preservation  of  youthfulness 
as  long  as  possible,  to  marry,  and  if  they  become  bereaved,  to 
marry  again.  Celibacy  is  a  condition  unknown  to  uncivilized 
nations ;  the  ancient  Hindoos  considered  it  a  crime  that  should  be 
punished ;  and,  according  to  Du  Perron,  the  Parsees  of  the  present 


Married  Life  as  Means  for  Prolonging  Life.  403 

time,  who  still  follow  the  religion  of  Zoroaster,  regard  celibacy 
as  a  deadly  sin.  According  to  Tsen-ki-tong,1  an  old  maid  is  a 
phenomenal  rarity  in  China. 

The  best  proof  of  the  supposition  that  marriage  is  conducive 
to  long  life  is  the  example  given  us  by  the  long-lived  patriarchs 
mentioned  in  another  chapter,  nearly  all  of  whom  were  married : 
for  if  they  became  widowers,  even  though  over  ioo  years  in  age, 
they  soon  married  again. 

It  is  one  of  the  saddest  sights  on  earth  to  see  an  old  bach- 
elor alone  in  the  world ;  and  we  consider  that  the  happiest  beings 
are  those  who,  in  their  green  old  age,  are  surrounded  by  numer- 
ous children  and  grandchildren.  According  to  Schopenhauer, 
such  persons  never  die,  for  their  flesh  and  blood  survive  in  their 
descendants. 

Being  still  a  bachelor  we  may  incur  the  reproach  that  we 
speak  of  marriage  as  the  blind  man  speaks  of  color,  and  par- 
ticularly by  seeming  blind  to  the  evils  that  may  be  present  in  the 
married  state.  We  cannot  deny  the  fact  that  some  people  are 
most  unhappy;  but  it  is  our  firm  belief  that  all  the  ills  that  befall 
us  on  this  earth  are  due  to  ourselves.  If  we  select  our  nuptial 
mate  with  care  and  sound  judgment,  paying  more  attention  to 
the  internal  rather  than  the  external  qualities,  treating  her  with 
the  utmost  consideration  of  character,  first  studying  and  then 
adapting  ourselves  to  them,  we  shall  not  find  sharp  edges  but 
smooth  sides,  and  we  shall  never  come  into  collision  with  them. 
Everywhere  and  anywhere,  everyone  is  the  author  of  his  own 
luck. 


1  Tsen-ki-tong:     "China  und  die  Chinesen,"  German  translation  from  the 
Chinese,  Leipzig,  1875. 


CHAPTER   LI. 

Hygiene  of  the  Mind — Emotions  and  Worry  as  Causes  of 

Old  Age. 

When  the  famous  surgeon  Vesalius  was  dissecting  a 
woman,  he  discovered  that  her  heart  was  still  feebly  beating. 
He  was  so  overcome  by  mental  distress  at  his  discovery  that 
he  suddenly  dropped  dead.  Other  instances,  also  showing  that 
strong  emotions  of  the  mind  are  able  to  kill  people,  are  known, 
and  history  also  tells  us  of  the  case  of  Louis  of  Bourbon  who 
dropped  dead  from  fright  at  witnessing  the  exhumation  of  his 
father's  bones.  Not  only  can  severe  emotions  caused  by  fear 
or  grief,  but  pleasing  ones,  when  they  exceed  a  certain  limit, 
are  also  able  to  produce  instantaneous  death.  Thus  it  is  said 
that  when  Leibnitz's  niece  found  a  large  amount  of  gold  under 
the  bed  of  the  famous  philosopher,  after  his  death,  she  had  such 
a  powerful  emotion  of  joy  that  she  fell  dead.  The  same  sudden 
end  was  the  fate  of  Sophocles  when  he  heard  that  one  of  his 
tragedies  had  been  awarded  the  highest  prize. 

Death  is  happily  rather  rare  under  such  circumstances ;  but 
diseases  of  a  serious  kind,  especially  diabetes,  can  be  caused 
frequently  from  strong  mental  emotions  of  a  depressing  nature. 
We  have  published  two  cases  of  young  women  who  suddenly 
contracted  severe  diabetes  after  a  fright,  while  previously  there 
had  been  no  symptoms  of  such;  and  in  a  third  case  glycosuria 
was  increased  very  considerably.  This  last  case  was  one  of  mild 
diabetes ;  the  sugar  increased  to  a  very  great  extent  the  day  fol- 
lowing the  intelligence  that  he  had  lost  half  his  fortune  through 
a  coal  mine  accident.  Professor  Naunyn,  in  his  book  on  dia- 
betes, after  quoting  our  own  observations,  also  states  the  inter- 
esting fact  that  after  the  bombardment  of  Strassburg  in  the 
(404) 


Emotions  and  Worry  as  Causes  of  Old  Age.  405 

war  of  1870,  many  cases  of  diabetes  developed  in  consequence 
of  the  fear  and  anxiety  brought  about  by  it. 

Strong  emotions  of  the  mind  thus  tend  to  shorten  existence 
by  their  fatal  action  on  several  of  the  most  important  organs, 
such  as  the  heart,  and  in  particular  the  ductless  glands :  the  ad- 
renals, thyroid,  pituitary,  pancreas,  liver,  kidneys,  and  the  sexual 
glands.  These  are  governed  by  the  sympathetic  and  vagus,  and 
mental  emotions,  by  acting  on  these  nerves,  produce  alterations 
in  these  important  glands. 

By  acting  on  the  adrenals  mental  emotions  produce  higher 
blood-pressure,  in  consequence  of  the  toxic  action  of  the  increased 
adrenal  secretion,  and  thus  favor  the  development  of  diseases  of 
the  heart  and  circulatory  system,  especially  arteriosclerosis,  which 
so  very  frequently  shortens  life  (see  also  Chapter  XVI). 

That  mental  emotions  act  upon  the  thyroid  is  shown  by 
the  alteration  of  this  gland  in  consequence,  which  can  sometimes 
go  so  far  that  often  Graves's  disease  (hyperthyroidia)  has  been 
observed,  at  times  shortly,  and  at  other  times  suddenly,  after  the 
mental  shock.  The  hyperactivity  of  the  thyroid  may  eventually 
be  followed  by  its  exhaustion;  and  so  it  happens  that  as  one  of 
the  causes  of  myxcedema  mental  depression  is  often  mentioned. 

That  alterations  of  the  pituitary  body  after  mental  emotions 
can  take  place,  is  shown  conclusively  by  the  fact  that  competent 
authorities,  like  Professor  Pel  and  many  others,  have  published 
cases  of  acromegaly  after  such  a  cause.  We  personally  observed 
a  case  in  which  grief  from  incarceration  caused  the  disease  to 
which  also  diabetes  was  added.  Sajous  has  long  urged  that  the 
pituitary  is  the  sensorium  commune,  i.e.,  the  central  organ  upon 
which  all  severe  emotions  react. 

It  is  indeed  tragical  that  diabetes  mellitus  SO'  frequently 
attacks  those  who  suffer  reverses  in  their  life.  Unlike  death 
in  the  cases  above  mentioned,  it  is  only  brought  about  in  those 
who  have  had  mental  emotion  in  consequence  of  disappointment, 
loss  of  fortune,  and,  in  some  cases,  a  wife's  infidelity,  etc.  Thus, 
not  satisfied  with  bringing  misfortunes,  Fate  adds  disease,   so 


406  Old  Age  Deferred. 


that  their  lives  are  threatened  with  being  shortened.  We  shall 
insist,  later  on,  that  this  disease,  as  most  diseases  generally, 
only  develops  in  consequence  of  our  own  fault  or  the  fault  of  our 
forefathers. 

The  alterations  of  the  pancreas  in  consequence  of  mental 
emotions  can  be  best  demonstrated  by  the  frequency  of  diabetes 
after  such  a  cause,  as  just  referred  to  above.  Pawlow  observed 
a  checking  of  the  pancreatic  juice  after  such  an  agency. 

The  action  of  mental  emotions  on  the  sexual  glands  is 
shown  by  the  sudden  appearance  of  menstruation.  We  have 
recently  heard  of  a  young  lady  who  attempted  suicide,  because  of 
disappointment  in  love;  she  threw  herself  into  a  river,  which 
fortunately  was  not  deep  at  the  moment,  and  this  act  caused  the 
sudden  return  of  her  menstrual  period. 

Cases  of  sudden  menstruation  after  various  kinds  of  mental 
emotion  have  often  been  observed ;  and  in  men  under  similar  cir- 
cumstances impotency  is  not  infrequently  noted,  though,  in  most 
cases,  it  is  only  temporary. 

The  alterations  of  the  liver  are  shown  by  jaundice,  and  of 
the  kidneys  by  an  increased  flow  of  urine  in  consequence  of  men- 
tal emotions.  According  to  Clifford  Allbutt,1  strong,  mental 
emotions  play  an  important  part  in  the  origin  in  many  cases  of 
interstitial  nephritis. 

It  is  a  well-known  fact  that  persons,  after  strong  mental 
emotion  of  a  distressing  kind,  have  suddenly  turned  gray,  as 
is  related  of  Marie  Antoinette,  Queen  of  France;  and  we  our- 
selves have  seen  a  similar  case  in  a  young  lady,  one  of  our  rela- 
tives, who  in  one  night  had  her  jet-black  hair  turned  white. 

That  care,  worry,  grief,  and  sorrow  are  able  to  bleach  the 
hair,  although  not  so  suddenly  as  above,  is  generally  known; 
and  not  only  gray  hair,  but  a  haggard,  worn  appearance,  and 
all  the  other  attributes  of  old  age,  with  changes  in  the  arteries,  as 
is  so  often  the  case  in  old  age,  have  over  and  over  again  been 
attributed  to  the  above  causes.     It  is  a  well-known  fact  that 


i  Quoted  after  James  Tyson,     hoc.  cit. 


Emotions  and  Worry  as  Causes  of  Old  Age.  407 

premature  old  age  is  probably  brought  about  more  frequently 
by  the  above  agencies  than  by  any  of  the  other  contributory 
causes. 

Not  only  premature  old  age,  but  also  premature  death,  can 
be  caused  by  such  agencies ;  for  there  is  no  longer  any  doubt  that, 
in  persons  with  mental  depression,  resistance  against  infections 
and  intoxications  is  reduced,  and  that  such  persons  are  thus  at  the 
mercy  of  the  microbes,  which  are  to  be  found  in  billions  every- 
where. On  the  other  hand,  we  can  often  observe  that  a  merry 
disposition  may  cause  long-lasting  youth  and  a  very  long  life. 
The  celebrated  English  painter,  Mr.  Frithe,  who  died  quite 
recently  at  the  age  of  92,  when  asked  the  reasons  for  his  vigor 
and  robustness  used  to  answer:  "No  worries,  and  six  cigars  a 
day."  Having  seen  on  the  island  of  Capri  an  old  boatswain  of 
80  years  vigorously  handling  his  oars,  we  inquired  of  him  the 
reasons  for  his  robustness  and  received  as  his  answer :  "Sempre 
allegre"  (always  merry).  This  "sempre  allegre"  should  also  be 
our  own  motto  for  life,  because  of  its  efficacy  in  warding  off  old 
age. 

There  are  some  admirable  teachings  in  the  Upanishads  and 
Vedanta  of  the  Hindoos :  never  to  seek  for  riches  and  fame,  and 
to  give  up  ambition.  Indeed  this,  more  than  anything  else,  would 
assure  a  perfect  tranquillity  of  the  mind,  as  exemplified  by  the 
image  of  Buddha ;  but  for  the  future  of  mankind  and  the  progress 
of  scientific  research,  a  certain  amount  of  ambition  is  necessary. 
We  think  the  noblest  aim  is  to  do  good  for  its  own  sake,  and 
not  for  the  sake  of  honors ;  but  if  honors  are  obtained,  to  accept 
them  calmly,  going  on  in  the  usual  way;  for  otherwise  it  hap- 
pens, as  we  so  often  witness,  that  too  much  ambition,  with  its 
wear  and  tear,  exposes  us  to  premature  disease  by  arterioscle- 
rosis, the  most  prevalent  disease  among  men  who  have  reached 
fame,  especially  among  statesmen,  whose  honors  are,  indeed, 
dearly  paid  for. 

It  would  lead  us  too  far  to  enter  into  particulars  as  to  how 
the  various  organs,  even  the  stomach,  can  possibly,  even  in  a 


408  Old  Age  Deferred. 


powerful  way,  influence  the  conditions  of  the  mind;  but  we  must 
make  an  exception  in  the  case  of  the  ductless  glands.  If  the 
mind  influences  these,  on  the  other  hand  they  exercise  a  mar- 
velous action  on  the  mind,  as  already  stated. 

Degenerated  conditions  of  the  thyroid  are  always  followed 
by  weakening  of  the  mental  powers,  and  they  are  also  able  to  alter 
the  normal  conditions  of  the  mind.  As  a  rule,  as  we  so  often  see, 
persons  having  such  are  low  spirited  and  possess  no  will-power 
or  energy.  The  loss  of  will-power  through  extirpation  of  the 
thyroid  or  by  its  degeneration  has  been  already  mentioned  in 
Chapter  IV. 

People  with  a  weak  thyroid,  and  especially  if  to  this  be 
added  a  degenerated  state  of  the  testicles,  or  of  the  ovaries  are 
usually  melancholy  and  despondent.  They  have  exceedingly 
often  what  the  French  call  "idees  noires" — they  are  always  full  of 
"dark  ideas."  In  everything  they  undertake  they  always  foresee 
a  bad  issue ;  and  it  is  not  singular  that  this  bad  issue  very  often 
really  comes  about,  for  it  is  caused  with  mathematical  certainty 
by  their  own  incapability,  absentmindedness,  and  entire  want  of 
foresight.  This  is  another  illustration  of  our  theory  that  most 
of  our  want  of  success  and  our  mishaps,  if  not  all  of  them,  we 
bring  upon  ourselves  by  our  own  faults.  We  often  notice  that 
such  people  lack  the  most  elementary  rules  of  foresight,  precau- 
tion and  circumspection.  They  are  horribly  absentminded,  a 
fact  we  have  noted  especially  in  old  spinsters,  who  may  pass  their 
best  friends  a  dozen  times  on  the  street  without  recognizing  them. 
Such  persons  may  also  easily  fall  victims  to  accidents,  as  being 
run  over  by  a  carriage,  etc. 

The  fact  that  these  "dark  ideas"  are  frequent  in  people 
with  a  degenerated  thyroid  has  also  been  observed  by  Dr.  Leo- 
pold Levi,  of  Paris,  and  Dr.  Baron  Henry  de  Rothschild,  who, 
in  their  Annals  on  Children's  Diseases,  published  by  Dr.  de 
Rothschild's  Hospital  for  Sick  Children,  give  a  detailed  de- 
scription of  the  alterations  in  the  mind  in  cases  of  thyroid  degen- 
eration.   That  these  dark  ideas  must  be  ascribed  to  degeneration 


Emotions  and  Worry  as  Causes  of  Old  Age. 


409 


of  the  thyroid  and  of  the  sexual  glands,  besides  the  proof  from  the 
observations  mentioned  in  Chapter  IV,  is  best  shown  by  the 
fact  that,  as  we  have  seen  in  many  cases,  they  may  be  much 
improved  and,  not  infrequently,  may  disappear  through  the  use 
of  thyroid,  testicular,  and  ovarian  extracts.  Courage,  as  was 
shown  in  the  same  chapter,  is  a  quality  of  the  mind  which  is 
entirely  dependent  upon  the  intact  condition  of  the  sexual  glands ; 
it  is  lacking  in  castrates,  and  seldom  seen  in  persons  with 
degenerated  sexual  glands. 

These  persons  are  like  a  reed  in  the  wind,  waving  backward 
and  forward  without  any  energy;  the  least  untoward  event  may 
beat  them  down.  They  are  pained  by  circumstances  and  are 
always  governed  by  them,  whereas  a  person  with  a  healthy  thy- 
roid and  healthy  testicles,  like  the  heroes  sculptured  by  the  Greek 
artists,  who  have  fire  and  courage  in  their  eyes,  faces  all  circum- 
stances. Such  as  these  control  all  circumstances,  sometimes  even 
fate,  and  it  is  not  fate  that  governs  them.  Sometimes  we  feel 
inclined  to  think  that  there  is  no  such  thing  as  fate,  at  least  for 
such  men.  They  mould  their  own  destiny  themselves,  and  always 
succeed  in  pushing  on  with  their  iron  will. 

Will-power  is,  as  repeatedly  mentioned,  essentially  a  product 
of  thyroid,  and  also  probably  of  intact  testicular  or  ovarian, 
activity.  It  is  always  wanting  in  persons  who  have  been  cas- 
trated, and  is  very  often  absent  in  those  leading  a  life  of  sexual 
debauchery. 

According  to  the  above,  persons  with  weak  thyroids  or  weak 
and  degenerated  sexual  glands  are  bound  to  fail  in  their  under- 
takings, and  are  thus  more  exposed  to  disappointments  of  all 
kinds,  reverses  of  fortune,  etc.;  therefore,  such  people  are  the 
most  frequent  subjects  of  mental  depression. 

Taking  into  consideration  what  has  been  said  above,  we 
conclude  that  the  source  of  disappointment  lies,  in  many  cases, 
if  not  in  most,  in  our  own  fault,  because  of  loss  of  foresight  or 
some  slight  omission,  which,  indeed,  is  so  often  apt  to  overthrow 
all  our  most  beautiful  plans.     Often  it  is  due  to  errors  of  judg- 


410  Old  Age  Deferred. 


ment,  and  frequently  also  to  want  of  perseverance,  the  conse- 
quence of  defective  will-power. 

We  have  already  shown  in  Chapter  IV,  and  above,  that 
degeneration  of  the  thyroid  and  of  the  sexual  glands  is  always 
followed  by  similar  alterations  of  the  mind. 

If  we  want  rationally  to  prevent  mental  depression  we  must 
first  remove  its  cause.  In  many  cases  it  is  caused  by  alterations 
of  mental  activity  subsequent  to  changes  in  different  ductless 
glands,  and  also  in  other  organs  that  influence  the  condition  of 
the  mind.  Logically,  we  must  improve  the  functions  of  these 
glands  if  we  want  to  proceed  rationally,  and  then  our  mental 
activity  will  improve,  and  failures  like  disappointments  may,  in 
all  probability,  be  avoided.  We  can  effect  this  by  means  of 
extracts  of  certain  animal  organs. 

It  has  been  shown  by  the  celebrated  physiologist,  Brown- 
Sequard,  by  experiments  on  himself,  that  testicular  extracts 
were  able  to  improve  his  mental  vigor  and  enabled  him  to  do 
a  much  greater  amount  of  work.  We  have  made  similar  ob- 
servations in  several  cases,  especially  when  at  the  same  time  thy- 
roid extracts  were  used,  but  also  without  them.  Thus  we  think 
that  we  do  not  go  too  far,  on  the  basis  of  the  observations  of 
Brown-Sequard  and  other  authorities,  including  our  own,  when 
we  say  that,  through  the  improvement  of  our  mental  power  by 
therapeutic  measures,  like  organic  extracts,  we  may  be  able  to 
influence  success  to  a  favorable  degree,  and  that  everybody  is,  in- 
deed, as  already  quoted,  "the  smith  of  his  own  luck,"  as  the 
German  proverb  says ;  and  thus  we  can  protect  ourselves  against 
failure,  disappointment,  and  mental  depression.  We  are  thus 
justified  in  saying  that  a  man  with  healthy  ductless  glands  in 
perfect  working  condition,  and  thus  of  perfect  mental  power,  is 
the  man  who  can  face  any  emergency  and,  to  a  certain  extent, 
direct  fate  at  his  own  pleasure.  Such  a  man  can  get  practically 
everything  he  wants,  and  Napoleon  probably  was  made  of  such 
stuff.    For  such  men  there  are  no  obstacles  in  the  world. 


2  Brown-Sgquard :    hoc.  cit. 


Emotions  and  Worry  as  Causes  of  Old  Age.  411 

It  is  of  great  importance  that  not  only  the  glands  with 
internal  secretion,  but  also  all  the  other  organs  of  the  body, 
should  be  kept  in  hygienic  condition,  carrying  out  the  rules  laid 
down  in  other  parts  of  this  book. 

It  has  been  shown  by  noted  historians  that  great  men,  such 
as  Napoleon,  had  to  blame  their  downfall  indirectly  to  faulty 
hygiene — for  instance,  of  the  digestive  organs.  That  the  con- 
dition of  the  stomach — this  too  often  ill-used  organ — influences 
the  mind  in  a  powerful  way,  is  borne  out  by  many  interesting 
examples. 

There  can  be  no  doubt,  however,  that  there  are  causes  of 
ill-luck  which  we  cannot  avoid,  as,  for  instance,  loss  of  near 
relatives  by  death,  such  as  parents  or  children,  or  disappointment 
in  nuptial  affection  or  love — although  here,  to  a  great  extent, 
omissions,  lack  of  sound  judgment,  and  last,  but  not  least,  lack 
of  perseverance  can  be  imputed. 

If  then,  in  spite  of  all  our  precaution,  an  accident  or  death 
of  a  dear  relative  occurs,  we  must  use  every  endeavor  to  control 
our  grief  and  sorrow.  Fortunately  the  human  frame  is  so  won- 
derfully built  that  there  is  self-defense  not  only  against  disease, 
but  also  against  affections  of  the  mind.  Thus  we  have  the  gift 
of  forgetfulness,  and  if  this  sometimes  be  a  drawback,  in  most 
cases  it  is  a  divine  blessing.  We  must  endeavor  to  obliterate  the 
remembrance  of  our  disappointments.  We  must  remember  that 
mourning  for  a  great  number  of  years  will  not  restore  life  for 
one  minute  to  the  dear  departed,  but  that  a  day  of  it  is  sufficient 
to  run  down  our  own  health  and  create  deep  furrows  in  our  face. 
Happily,  average  man  is  so  constituted  that,  as  time  goes  on, 
he  must  naturally  lose  his  sorrow ;  time  heals  all  grief,  and  here 
also  will-power  has  its  effects;  and  those  who  lack  it,  examples 
of  whom  we  have  referred  to  above,  are  easily  subject  to  suicide. 

It  would  also  be  necessary  to  change  such  of  our  habits 
as  are  allied  to  superstition  and  prejudice.  As  in  many  things, 
the  Chinese  are  more  rational  in  their  customs ;  at  their  times  of 
mourning  every  one  is  dressed  in  shining  and  beautiful  white; 


412  Old  Age  Deferred. 


they  use  a  white  coffin,  which  is  much  more  pleasing  to  the  sight, 
and  certainly  much  more  cheerful,  than  our  depressing  dark 
ones ;  and  when  the  whole  house  and  church  are  draped  in  black 
our  depression,  with  its  terrible  consequences  to  our  health  and 
vitality,  is  so  much  the  more  increased.  Thus  the  dead  often 
shorten  the  lives  of  the  living. 

Then,  living  in  total  seclusion,  garbed  in  deep  black,  with 
long  black  veil,  remaining  away  from  all  places  where  the  mind 
can  be  cheered,  not  even  allowed  to  attend  a  concert,  how  can 
a  poor  widow  forget,  especially  if  her  will-power  from  causes 
mentioned,  is  diminished?  Shall  we  then  be  greatly  surprised 
if,  as  occurs  occasionally,  such  a  widow  or  widower  commits 
suicide,  to  which  such  irrational  prejudices  are  simply  impelling 
them? 

And  yet  it  will  certainly  not  be  impossible  to  ameliorate 
such  a  state.  With  a  strong  will-power  systematically  trained 
from  childhood,  we  can  accustom  ourselves  to  drive  out  dis- 
agreeable thoughts  of  bereavement,  fear,  anxiety,  etc.  Realizing 
that  what  is  irreparably  lost  can  never  be  recovered,  notwith- 
standing oceans  of  tears  and  the  deepest  sorrow,  we  must  suc- 
ceed in  understanding  the  uselessness  of  it  and  make  up  our 
mind  to  eradicate  entirely  from  our  recollections  things  that  can 
never  be  altered.  Not  to  worry  about  anything  is  the  surest 
and  most  successful  way  to  attain  long  life  and  a  green  old  age, 
and  by  the  exercise  of  some  will-power  and  consistent  training 
such  a  mental  condition  can  be  obtained. 

There  are  certain  external  agencies  which  can  powerfully 
assist  to  bring  about  f  orgetf  ulness.  Such  are  music,  the  arts,  litera- 
ture, and  above  all  scientific  occupations.  Where  is  there  a  grief 
that  cannot  be  soothed  by  one  of  the  beautiful  symphonies  of  Bee- 
thoven, or  by  the  works  of  Mozart,  or  by  other  classics :  Haydn, 
Haendel,  Bach,  Schubert,  Chopin,  Wagner,  Grieg;  or  by  the 
paintings  of  Velasquez,  Rembrandt  or  Van  Dyck;  or  by  the 
pictures  of  the  beautiful  women  painted  by  the  great  English 
masters  Gainsborough,  Reynolds,  Romney,  and  Lawrence;  and 


Emotions  and  Worry  as  Causes  of  Old  Age.  413 

which  of  the  saddest  faces  will  not  turn  to  a  smile  when  reading 
Mark  Twain  ?  The  pursuit  of  scientific  research  is  also  a  mighty 
weapon,  and  we  know  a  famous  savant  who  passed  the  remainder 
of  the  day  in  his  laboratory  after  he  had  accompanied  the  hearse 
of  his  wife  to  the  cemetery. 

When  we  are  deeply  depressed  over  a  severe  loss  if  we  pay  a 
visit  to  a  museum,  where  we  can  see  the  manifestations  of  life 
that  existed  hundreds  or  thousands  of  years  ago,  it  may  give 
us  some  comfort.  Considering  the  bodies  in  the  British  Museum 
of  Egyptian  kings  and  queens,  etc.,  that  lived  thousands  of  years 
ago,  together  with  the  jewels  that  they  were  wearing,  and  all  the 
other  signs  of  splendor  that  existed  so  many  ages  before,  we  ask : 
in  the  face  of  these  thousands  of  years  what  are  those  few  years 
of  worry  on  earth  ?  As  Schopenhauer  said  :  "The  world  existed 
50,000  years  ago,  and  will  last  50,000  years  more,  and  what  are 
the  few  years  of  our  life  in  face  of  these  thousands?" — and  we 
would  like  to  say  "in  face  of  these  millions"  of  years,  as  the 
scientific  history  of  mankind  attests. 

A  trip  to  the  country,  mountains,  forests,  or  seaside,  being 
out  in  the  flower-covered  fields  and  sunshine,  and  especially 
foreign  travel,  thereby  changing  all  our  surroundings  and  habits, 
should  soon  be  able  to  soothe  our  sorrows.  In  early  childhood  a 
love  for  the  fine  arts,  music,  painting  and  literature  should  be 
developed,  as  these  form  a  valuable  support  for  the  mind  in  later 
years.  A  knowledge  of  Latin  and  Greek,  which  are  soon  for- 
gotten, should  not  be  the  aim  of  the  school  education,  but  rather 
the  refinement  of  character  in  the  child. 

The  most  valuable  aid  in  the  treatment  of  mental  depres- 
sion is  religion,  for  this  gives  what  nothing  else  can  give  in  equal 
degree — Hope !  Hope,  without  which  we  should  always  exist  in 
continual  gloom !  We  will  point  out,  in  a  few  words  in  the  next 
chapter,  the  advantages  of  religious  belief. 


CHAPTER   LII. 

Hygiene  of  the  Mind — Religious  Belief  as  a  Means  of 
Prolonging  Life. 

A  religious  lady  of  the  Dutch  aristocracy,  whom  we  have 
known  for  years,  lost  within  a  short  time  both  her  grown-up 
son  and  her  husband,  to  whom  she  was  most  devotedly  attached. 
Imagining1  that  she  must  have  been  completely  crushed,  we 
inquired  of  a  member  of  the  family  how  she  had  sustained  these 
terrible  losses.  The  answer  was  that  she  was  perfectly  calm  and 
that  she  was  the  most  composed  member  of  the  whole  family. 

We  know  from  personal  observation  that  this  lady  was  truly 
religious ;  and  we  are,  therefore,  inclined  to  believe  that  only  her 
great  sense  of  religion  enabled  her  to  withstand  so  well  these 
terrible  shocks.  Her  case  is  a  typical  one,  showing  that  persons 
of  a  truly  religious  belief  are  better  able  to  withstand  depressing 
impressions.  They  will  not  give  way  to  despair  so  readily  as 
most  irreligious  people,  and  it  is  exceedingly  rare  to  find  a  case 
of  suicide  among  such. 

Not  only  will  truly  religious  people  avoid  suicide  and  mental 
depression,  with  all  their  fatal  consequences,  as  we  have  shown 
in  the  preceding  chapters,  but  they  will  also,  as  a  rule,  withstand 
diseases  better  than  others.  As  we  have  noted,  truly  religious 
people,  when  seriously  ill,  have  such  a  strong  faith  and  hope  in 
their  recovery — they  invariably  are  convinced  that  God  will  help 
them — that  this  has  proved  to  us  a  most  invaluable  aid  in  their 
medical  treatment.  The  importance  of  this  fact  is  also  confirmed 
by  our  friend,  Dr.  Eberson,  one  of  the  busiest  practitioners  in 
Amsterdam,  who  remarked  to  us  that  the  outlook  for  recovery 
was  always  more  favorable  in  such  cases.  As  Prof.  Charles  Beck, 
of  New  York,  told  us,  he  often  remarked  that  his  religious 
(414) 


Religious  Belief  as  a  Means  of  Prolonging  Life.        415 

patients  could  stand  narcosis  better:  they  showed  less  anxiety, 
and  thus  the  heart  action  became  less  excited.  Thus  religion  can 
undoubtedly  tend  to  prolong  life;  and  in  this  we  are  not  saying 
anything  novel,  for  it  is  well  known  that  the  mind  has  a  wonder- 
ful influence  over  the  body.  Religion  acts  on  the  mind,  and  the 
mind  powerfully  governs  the  body. 

This  is  made  use  of  by  certain  religious  sects  in  what  are 
known  as  "faith  cures;"  and  that  in  certain  cases,  and  especially 
in  nervous  diseases,  such  as  hysteria  or  neurasthenia,  these  cures 
may  be  of  service,  cannot  be  denied  on  the  ground  of  the  above 
observations. 

The  influence  of  the  mind  over  the  body  was  recognized 
hundreds  of  years  ago  by  all  great  physicians.  The  great  phi- 
losopher, Kant,1  insisted  upon  it  in  a  special  article,  and  Char- 
cot has  effected  some  wonderful  cures  by  such  means  in  hys- 
teria, as  have  hundreds  of  other  physicians.  We  all  agree,  for 
we  see  it  every  day,  that  the  mind  governs  the  body;  but  there 
are  also  certain  agencies  that  govern  the  mind,  and  religion  is 
one  of  the  most  important  of  these. 

Therefore,  happy  are  they  who  are  truly  religious,  for  their 
days  may  be  longer,  and  they  are  better  prepared  to  meet  the 
vicissitudes  of  life ! 

There  are  many  scientific  people  who  do  not  believe  in  a 
Superior  Being  because  His  presence  cannot  be  scientifically 
proved.  But  there  are  many  things  that  are  quite  inexplicable, 
but  which  none  the  less  do  exist,  and  in  which  we  do  believe. 
Are  there  not  many  such  things,  even  in  medicine,  which  are  most 
mysterious,  but  nevertheless  true?  If  we  consider  the  human 
body  we  find  that  to  the  smallest  details,  to  the  minutest  of  the 
millions  and  millions  of  cells  of  which  it  is  composed,  it  is  built 
up  in  a  most  marvelous  way.  It  is  admirable  with  what  in- 
genuity and  forethought  the  smallest  particles  are  put  together 
to  suit  one  another.  There  may  be  an  artistic  genius  who  can 
erect  one  wonderful  construction,  as  a  masterpiece  of  art;  but 

i  Journal  der  pract.  Arzneikunde,  vol.  v,  1788. 


416  Old  Age  Deferred. 


in  the  human  body  the  microscope  will  reveal  thousands  and 
thousands  of  such  masterpieces,  perfect  in  the  smallest  details, 
which  no  artist  could  be  capable  of  putting  together  and  of 
making  them  work  admirably  in  unison. 

And  the  physician  must  be  an  artist,  too,  to  discover  which 
of  the  wheels  in  this  most  wonderful  machinery  are  not  doing 
their  duty;  and  if  it  took  but  a  second  to  conceive  a  human 
body,  it  takes  a  whole  lifetime  to  study  all  the  recesses  and 
angles  of  this  masterpiece  of  mechanism. 

The  admirable  forethought  with  which  the  different  parts 
are  formed  in  man  or  animal,  must  give  us  the  idea  that  it  must 
be  the  sequence  of  a  cause,  as  indeed  there  is  in  this  world  no 
effect  without  a  cause;  and  this  cause  must  be  the  action  of  a 
Superior  Power. 

To  give  one  of  the  numberless  examples  for  the  truth  of 
this,  we  should  like  to  quote  the  ingenious  mechanism  affecting 
the  eyes  of  certain  young  animals,  such  as  dogs.  As  is  well 
known,  puppies  cannot  see  for  a  few  days  after  birth,  but  are 
prevented  from  so  doing  by  a  delicate  mucous  membrane  that 
covers  their  eyes.  And  yet  there  is  a  cause  for  this,  which  cause 
is  the  result  of  a  most  tender  circumspection ;  for  these  little 
animals  are  provided  with  this  membrane  so  that  strong  light,  like 
sunshine,  shall  not  irritate  the  eye  until  certain  modifications  have 
taken  place  in  the  inner  eye,  which  allow  these  parts  to  stand  such 
a  light;  and  as  this  requires  a  few  days,  the  membrane  in  ques- 
tion closes  the  eye  during  that  time.  It  seems  as  if  Almighty 
Nature  stands  with  her  hands  over  the  eyes  of  these  puppies  to 
protect  them  from  being  harmed  by  the  light. 

Maternal  love  is  a  necessity  in  all  animals  to  save  the  race 
from  extinction.  There  are  a  few  exceptions  in  which  animals 
occasionally  kill  their  young  for  certain  reasons ;  but  this  is  con- 
fined to  a  few  of  them  such  as  cats  and  dogs,  and  only  happens  the 
first  or  second  days  after  labor,  being  due  probably  to  mental 
alterations  induced  by  the  processes  of  birth ;  it  may  happen  also 
in  man.     It  is  truly  marvelous  how  insects  provide  for  their 


Religious  Belief  as  a  Means  of  Prolonging  Life.        417 

descendants,  which  they  will  never  see,  for  they  themselves  die 
prior  to  their  development.  An  interesting  example  has  been 
lately  quoted  by  a  naturalist.  The  wasp,  before  dying,  thinks  of 
a  most  ingenious  way  for  providing  food  for  her  larvae.  This  is 
in  the  form  of  a  worm;  but  as  this  worm  would  putrefy  before 
the  development  of  the  larvae,  the  wasp  does  not  kill  the  worm 
but  merely  stings  it  in  the  spinal  cord.  This  does  not  kill  the 
worm,  but  simply  paralyzes  it,  and  thus  the  worm  will  live  on  till 
the  larvae  are  developed,  when  there  they  will  find  their  food 
ready  prepared  for  them  by  their  far-seeing  mother.  "Who  is  the 
cause  of  such  foresightedness  being  given  to  these  insects? 

There  are  certain  people  who  cannot  believe  in  a  Supreme 
Being,  because  injustice,  mishaps,  and  accidents  happen  daily. 
But  there  are  natural  laws  which  must  pursue  their  course. 
When  a  child  falls  out  of  a  top  floor  window  and  is  killed  on  the 
pavement  below,  the  law  of  gravity  is  acting;  but  the  accident 
may  be  due  also  to  a  want  of  foresight  on  the  parents'  part. 
If  disease  overtakes  us  it  is  also  frequently,  if  not  always,  due  to 
our  own  fault,  or  that  of  our  forefathers.  On  the  other  hand, 
we  see  the  wonderful  work  of  Nature;  for,  as  already  shown  in 
Chapter  III,  our  body  is  wonderfully  provided  with  every  means 
of  defense  against  disease;  and  like  a  careful  mother,  Nature 
warns  us  first,  for  hardly  ever  do  wre  get  ill  without  there  being 
some  premonitory  symptoms.  Thus,  before  chronic  kidney  af- 
fections come  on,  we  eliminate  for  some  months,  and  sometimes 
longer,  casts ;  and  before  diabetes  comes  on  traces  of  sugar,  as  a 
rule,  appear  in  the  urine  for  a  certain  time;  and  then  is  the 
time  for  us  to  follow  a  diet  in  order  to  avoid  these  diseases.  In- 
fectious diseases  also  give  warning  symptoms  before  they  de- 
velop, and  these,  as  well  as  others,  may  sometimes  be  prevented 
by  a  timely  defense  and  certain  hygienic  measures  on  our  part. 
Even  against  poisonous  animals  we  are  protected  in  a  wonderful 
way.  Thus,  before  the  rattlesnake  bites  he  utters  a  warning  by 
his  rattles,  and  before  the  mosquito  gives  us  malaria  through  its 
sting  a  premonitory  hum  falls  on  our  ear.     Unfortunately  we 

27 


418  Old  Age  Deferred. 


have  not  sufficient  space  to  give  further  examples  of  the  admir- 
able way  in  which  a  Superior  Power  is  doing  His  best  to  protect 
us,  and  if  mishaps  do  very  often  occur,  very  frequently,  if  not 
always,  as  already  mentioned,  it  may  be  traced  to  certain  of 
our  own  actions. 


CHAPTER  LIIL 
Disease  Considered  as  a  Self-defence  of  Nature. 

Many  a  man  bemoans  his  fate  when  bed-ridden  and  tor- 
tured by  pain,  and  yet  we  cannot  fail  to  recognize,  upon  further 
consideration,  that  such  suffering  often  serves  but  to  pave  the 
way  for  recovery.  Very  frequently  the  advent  of  slight  pain  is 
the  earliest  indication  that  something  in  our  organism  is  amiss, 
and  promptly  leads  us  to  think  of  measures  for  the  prevention  of 
further  trouble.  A  sickness  can  often  be  controlled  at  the  outset 
upon  using  proper  measures,  and  thus  entirely  averted.  Severe 
pains  not  infrequently  mean  the  saving  of  life,  since  they  compel 
indolent  or  careless  persons  to  seek  the  physician's  help  while 
there  is  still  time.  How  few  persons,  indeed,  would  consult  the 
doctors  and  discontinue  excessive  eating,  were  they  not  forced  to 
do  so  by  their  aches  and  pains. 

Not  a  few  diseases  are  to  be  classed  as  serious  and  dangerous 
to  life  owing  to  the  fact  that,  of  themselves,  they  do  not  give  rise 
to  discomfort,  and  lull  their  victims  into  a  false  sense  of  security. 
Many  a  diabetic  would  live  longer,  were  he  reminded  by  torment- 
ing pains  of  the  necessity  of  careful  treatment  and  restriction  in 
his  diet.    Thus  even  pain  is  of  service  to  mankind. 

Other  annoying  symptoms  of  disease  must  also  be  regarded 
as  expressions  of  nature's  efforts  towards  self-cure.  When  a 
person  makes  use  of  an  article  of  food  that  has  undergone  deteri- 
oration, nature  often  endeavors  to  remove  it  by  an  evacuation 
of  the  intestinal  canal.  Again,  no  harm  is  done  when  a  glutton 
at  length  upsets  his  stomach,  loses  his  appetite,  and  allows  the 
ill-used  organ  to  rest.  And  he  is  being  let  off  cheaply,  if  his  over- 
burdened stomach  procures  its  own  relief  by  vomiting.  When  a 
person  has  an  attack  of  gout  and  sweats  profusely,   noxious 

(419) 


420  Old  Age  Deferred. 


substances  are  likewise  eliminated  thereby.  When  the  illness  is 
over,  however,  one  feels  not  infrequently  all  the  more  fresh  and 
rested  after  convalescence,  whence  the  ancient  Greeks  not  incor- 
rectly said:    "To  7ra0os  idrpos  «rri." 

Indeed  that  sickness  is  oftentimes  directly  beneficial  in  its 
effects  is  a  matter  of  frequent  observation.  If,  for  example,  a 
markedly  obese  person  becomes  diabetic — in  such  cases  the 
disease  appears  in  a  mild  form,  as  a  rule, — his  chances  of  long 
life  are  thereby  not  infrequently  improved.  I  observed  this  in  the 
case  of  an  American  lady  who  weighed  162  kilogrammes  (357 
pounds).  The  mild  form  of  diabetes  which  this  lady  developed 
was  certainly  not  to  her  detriment,  for  whilst  she  could  lose 
weight  as  a  result  and  live  for  a  long  period,  her  situation  would 
have  been  far  different  had  the  obesity  progressed  still  further. 

We  have  already  endeavored  to  show  that  fever  is  in  reality 
an  expression  of  efforts  of  the  body  at  self-healing,  as  we  like- 
wise maintained  with  reference  to  skin  affections.  So,  too,  the 
syphilitic  patient  who  exhibits  diffuse  skin-eruptions,  as  well  as 
other  localized  manifestations  in  the  peripheral  tissues,  has  a 
better  outlook  with  respect  to  the  dreadful  nervous  consequences 
of  this  disease  than  one  who  never  exhibits  the  outer  signs  of  the 
infection. 

We  perceive,  therefore,  that  that  which  we  call  disease  is 
nought  else  but  nature's  attempt  to  attain  health — a  kind  of 
defensive  reaction  against  harmful  substances.  The  disease 
proper  has  often  already  been  present  for  some  time ;  it  already 
exists  at  the  very  instant  in  which  the  invading  foe  makes  its 
entrance  into  the  body.  Between  this  time  and  the  moment  when 
the  reaction  of  the  body, — that  is,  what  we  are  in  the  habit  of 
calling  the  disease, — appears,  a  considerable  period  may  fre- 
quently elapse;  oftentimes  it  may  even  extend  through  several 
years,  as  in  leprosy  or  in  the  sleeping  sickness.  It  would  thus  be 
entirely  rational  to  interfere  at  a  time  when  the  enemy  has  not 
yet  penetrated  into  the  body.  Unfortunately  the  signs  which 
might  acquaint  us  with  its  presence  have  not  at  that  time  found 


Disease  as  a  Self-defence.  421 

distinctive  expression.  Vague  symptoms  such  as  mild  headache, 
want  of  appetite,  lassitude,  low  spirits,  etc.,  may  alone  exist,  and 
yet  it  is  necessary  that  even  these  should  be  watched  for.  Already 
in  this  period  it  would  be  advisable  to  seek  the  physician's  aid,  and 
if  many  be  deterred  therefrom  because  of  the  expense  involved,  it 
should  be  recalled  that  oftentimes  fifty  visits  cannot  procure  the 
result  which  might  have  been  obtained  by  a  few  preventive 
measures.  Thus  the  very  mildest  symptoms  of  illness  are  not 
to  be  disregarded, — a  fact  with  which  children  in  particular  must 
be  impressed.  Older  persons  and  teachers  should  likewise  be 
made  familiar  with  this  precept.  What  a  multitude  of  human 
lives  could  be  saved  in  this  way! 

But  in  order  to  recognize  the  slightest  indications  of  an 
approaching  illness,  deviations  from  the  normal  state  of  health 
would  have  to  be  closely  studied.  The  science  which  apprises 
us  of  the  functions  of  normal  organs  would  have  to  be  given 
more  extensive  recognition,  and  physiology  would  have  to  become 
the  basis  of  the  physician's  every  thought  and  method  of  treat- 
ment. The  system  prevailing  among  the  Chinese,  who  in  many 
ways  surpass  us  in  logic,  and  who  pay  the  doctor  only  so  long  as 
they  are  in  health,  is  thus  not  so  unreasonable.  The  best  plan 
of  all  would  be  for  each  family  to  have  its  own  house-physician, 
whom  it  could  consult  regularly,  especially  if  there  be  children; 
for  such  a  person  alone  is  capable  of  recognizing  the  earliest 
deviations  from  the  normal.  The  prevention  of  disease  would 
have  to  constitute  the  basis  of  all  our  therapeutic  endeavors. 

In  order  to  become  of  real  assistance  to  Nature,  however, 
the  physician  must  be  continually  following  in  the  wake  of  her 
efforts  to  secure  health.  If  the  defensive  reaction  brought  about 
by  Nature  against  toxic  materials  is  too  feeble,  he  must  assist 
her  by  proper  remedies.  Thus  when  the  use  of  spoiled  food  is 
followed  by  diarrhoea,  he  must  not  arrest  the  latter ;  otherwise  he 
would,  indeed,  be  locking  the  wolf  in  with  the  sheep.  On  the 
contrary,  he  must  imitate  Nature  and  accordingly  administer  a 
purgative.     Again,  if  on  taking  cold  or  during  a  gouty  attack  a 


422  Old  Age  Deferred. 


person  falls  into  a  profuse  sweat,  it  would  certainly  be  illogical 
to  administer  a  remedy  to  counteract  this  beneficent  influence; 
another  means  of  producing  perspiration  should  rather  be  availed 
of,  as,  for  example,  the  salicylates.  If,  on  the  other  ,hand,  the 
reaction  is  too  strongly  marked,  as,  for  instance,  in  a  young  girl 
with  very  active  thyroid  gland,  who  in  consequence  of  typhoid 
exhibits  a  dangerous  rise  of  temperature  or  hyperpyrexia,  then 
the  physician  must  put  on  the  brakes  and  save  her  life  by  appro- 
priate antipyretic  measures. 

In  view  of  the  above  deductions,  it  is  not  unjustifiable  to 
believe  that  the  symptoms  of  disease,  i.e.,  what  we  designate  as 
disease,  together  with  many  other  supposed  ills,  in  reality  con- 
tribute toward  the  preservation  of  mankind. 


CHAPTER  LIV. 

Hygiene  of  the  Mind— Advice  to  Brain  Workers. 

Scholars,  who  live  entirely  from  the  product  of  their  mental 
labors,  often  do  not  present  a  healthy  appearance,  and  are  not 
infrequently  subject  to  nervous,  gastric  or  intestinal  disorders, 
chronic  constipation,  etc.  In  laborious  mental  activity  an  exces- 
sive amount  of  blood  flows  to  the  brain,  that  of  other  organs 
being  withdrawn,  and  thus  diminished  formation  of  gastric  juice 
is  favored  and  the  appetite  reduced.  Intellectual  activity  should, 
if  possible,  be  suspended  a  full  hour  before  and  after  meals. 
Congestion  of  the  brain  likewise  interferes  with  proper  sleep, 
which,  as  a  rule,  can  only  become  truly  deep  when  the  brain  is 
bloodless.  Intellectual  efforts  should  therefore  be  avoided  for  a 
period  of  one  to  two  hours  before  going  to  bed,  and  especially 
one  should  not  read  in  bed. 

After  a  good  night's  sleep  the  brain  is  adequately  rested  and 
hence  capable  of  doing  the  most  work.  For  this  reason  the 
morning  hours  are  the  best  of  all  for  mental  labor ;  the  very  early 
hours  have  the  additional  advantage  of  absolute  quiet  and 
freedom  from  disturbance.  Personally  I  work  preferably  from 
5  to  8  o'clock  in  the  morning,  especially  in  the  winter  time  when 
one  cannot  well  go  out  walking  so  early. 

In  a  previous  chapter  I  mentioned  the  fact  that  organs  upon 
which  great  demands  are  made  more  readily  become  the  seat  of 
arteriosclerosis  because  of  the  abundant  flow  of  blood  to  them.  In 
persons  of  great  intellectual  activity  we  accordingly  find  marked 
sclerosis  of  the  cerebral  arteries,  especially  if  they  have  the 
bad  habit  of  smoking  and  drinking  excessively.  Besides,  drinking 
interferes  with  the  quality  of  work  done.  The  influence  of  smok- 
ine  in  the  production  of  arteriosclerosis  we  have  already  dis- 

(423) 


424  Old  Age  Deferred. 


cussed.  Under  normal  conditions  intellectual  workers  can  live 
to  an  advanced  age — this  we  know  from  numerous  celebrated 
instances :  Hippocrates,  Democritus,  Plato,  Plutarch,  Leibnitz, 
Newton,  Galileo,  Michael  Angelo,  Carlyle,  etc.  Socrates  wrote 
his  Panathenae  in  his  94th  year,  the  celebrated  Dr.  Hufeland  the 
fifth  edition  of  his  "Makrobiotik"  at  a  ripe  old  age,  while  Goethe's 
powers  of  execution  remained  to  the  last  undiminished.  Recently 
I  received  from  an  English  colleague  80  years  of  age,  who  had 
attained  eminence  by  his  studies  on  metabolism,  an  excellent  work 
on  diabetes,  which  he  had  just  brought  out. 

With  but  very  few  exceptions,  we  find  that  the  great  master- 
intellects  who  attained  to  an  advanced  age  led  lives  of  modera- 
tion in  every  respect — not  only  as  to  their  bodies,  but  also  their 
minds.  Whoever  lives  as  hygienically  as  did  Newton,  can,  like 
him,  become  very  old  in  spite  of  bodily  weakness.  Newton  was 
a  very  frugal  eater,  had  no  passions  and  never  worked  until 
over-fatigued.  Not  to  work  to  excess,  to  permit  one's  self  to  rest 
at  the  proper  time — this  is  the  chief  precept  in  the  hygiene  of 
the  mind.  The  brain  requires  rest  even  more  than  any  other 
organ  from  which  great  activity  is  demanded.  One  should  not 
work  more  than  a  few  hours  at  a  stretch. 

I  strongly  recommend  going  to  bed  at  ten  or  eleven  o'clock, 
rising  at  five  to  half-past  six  o'clock,  and  then  after  refreshing 
one's  self,  at  once  settling  down  to  work.  Breakfast  may  be 
eaten  at  about  eight  o'clock.  A  walk  should  then  be  taken  before 
going  back  to  work,  which  should  be  interrupted  an  hour  before 
dinner-time  and  only  resumed  an  hour  after  the  meal.  In  the 
warmer  seasons  it  is  best  to  work  in  the  garden  or  in  the  woods 
whenever  the  nature  of  the  work  permits.  It  is  advisable  to  leave 
off  one  hour  before  supper,  and  then,  as  a  general  rule,  do  nothing 
further,  but  take  a  walk,  if  possible  also  before  supper.  In 
general,  mental  workers  need  plenty  of  exercise  in  the  open  air; 
especially  in  the  woods  or  elsewhere  in  the  midst  of  foliage  is  the 
flow  of  ideas  more  easily  aroused.  When  it  is  not  too  hot,  one 
may  sit  out  in  the  sun  while  working,  though  the  eyes  and  the 


Advice  to  Brain  Workers.  425 

book  or  paper  should  be  shaded.  The  combination  of  pure  air, 
sunshine,  and  mental  occupation  is  of  great  value.  Laboratories 
and  libraries  should  be  so  disposed  as  to  correspond  strictly  to  all 
rules  of  hygiene  regarding  air  and  light. 

In  winter  time  one  gains  distraction  by  visiting  friends, 
attending  society  meetings,  concerts,  theatres,  etc.  In  every 
season  of  the  year  it  would  be  well  to  spend  Sundays  in  the 
country.  It  is  necessary,  likewise,  to  follow  the  general  rules  of 
hygiene.  Insofar  as  the  diet  is  concerned  it  is  strongly  to  be 
recommended  during  heavy  mental  labor,  especially  where  much 
thinking  is  required,  that  meat-eating  be  given  up  and  a  vegeta- 
rian diet,  with  the  addition  of  milk  products  and  eggs,  adopted. 
At  any  rate,  a  diet  rich  in  meats  must  be  avoided ;  it  not  only 
makes  one  heavy  and  dull,  but  also  creates  a  want  for  alcohol, 
coffee,  tobacco  and  other  unwholesome  stimulants,  for  which  a 
diet  containing  little  or  no  meat  need  evoke  no  desire. 

Regularity  and  moderation  heighten  the  expectations  of  long 
life  in  mental  workers  and  guard  against  the  premature  failure 
of  the  intellectual  powers  which  must  sooner  or  later  follow  upon 
overwork.  This  not  infrequently  happens  quite  early  in  life. 
Boerhave  could  already  cite  two  such  cases;  "I  have  known  a 
young  man  who  knew  everything  and  was  a  prodigy  of  learning, 
but  who  hardly  lived  to  the  age  of  25,  and  another  who  worked 
day  and  night  with  the  industry  of  a  bee,  and  without  any 
definite  illness  died  in  his  nineteenth  year  in  a  state  of  emacia- 
tion." In  common  with  scholars  and  men  of  letters  physicians 
must  take  particular  care  of  themselves,  their  brains  being  con- 
tinually on  a  stretch.  The  efforts  they  make  to  prolong  the  lives 
of  others  shorten  their  own — the  irony  of  fate!  Few  callings 
demand  as  much  mental  work  as  that  of  the  medical  man.  We 
physicians  often  have  to  deal  with  infectious  diseases;  since  the 
continued  mental  strain  is  capable  of  injuring  our  bodily  health 
and  hence  diminishing  our  resisting  power  against  infections,  it 
is  advisable  for  us  as  far  as  possible  to  avoid  all  harmful  influ- 
ences,— and  especially  excess  of  any  kind. 


CHAPTER  LV. 

On  the  Prevention  of  Premature  Old  Age,  and  the  Treat- 
ment of  Old  Age,  through  Certain  Drugs: 
Arsenic,  Iron,  and  Iodides. 

It  can  often  be  observed  that  people  who  habitually  take 
arsenic,  either  for  medicinal  or  other  purposes,  look  better  and 
younger;  and  we  have,  ourselves,  noted  in  some  of  them  a  dis- 
appearance of  wrinkles.  Wrinkles  are  caused  by  the  loss  of  the 
fatty  tissue  from  under  the  skin,  and  as  arsenic  causes  an  increase 
of  fat  in  the  tissues  it  may  improve  such  a  condition. 

As  is  well  known  in  some  parts  of  Europe,  notably  in 
Styria,  the  habit  of  eating  arsenic  is  very  prevalent  among  the 
peasants ;  and  it  is  strange  to  note  that  most  of  these  people  live 
to  a  great  age,  and  at  the  same  time  are  extremely  immune 
to  all  kinds  of  bodily  fatigue — for  instance,  they  can  climb 
the  highest  peaks  in  their  native  mountainous  country  without 
great  exertion.  They  take  arsenic  because  it  enables  them  to 
undertake  harder  work,  such  as  climbing,  with  greater  ease,  and 
also  improves  their  appearance. 

We  have  known  several  ladies,  famous  actresses  among 
them,  who  have  indulged  in  this  habit  from  vanity.  A  very 
interesting  case  was  tried,  about  ten  years  ago,  before  an  Aus- 
trian court  of  justice,  in  which  a  servant  girl  tried  to  poison  her 
mistress  by  arsenic  in  small  quantities.  To  the  dismay  of  the 
servant,  however,  the  lady  continued  to  become  more  beautiful; 
so  the  murderess  determined  to  give  a  larger  dose,  which  in- 
duced grave  symptoms  of  intoxication,  and  caused  the  discov- 
ery of  the  plot. 

It  is  equally  well  known  that  animals  obtain  a  glossy  and 
sleek  coat  through  the  administration  of  arsenic  in  small  quan- 
tities. 

(426) 


Prevention  of  Premature  Old  Age  Through  Drugs.     427 

There  can  be  no  doubt  that  when  arsenic  is  taken  in  small 
quantities  it  may  prove  of  therapeutic  value  against  old  age; 
but  as  very  aged  people  are  often  antagonistic  to  its  use,  it  would 
seem  to  offer  better  results  if  used  as  a  preventive  against 
premature  old  age  rather  than  as  a  cure  after  old  age  had  much 
advanced. 

As  arsenic  can  give  good  results,  especially  in  combination 
with  iron,  in  ansemia,  and  also  in  neurasthenia  and  hysteria,  we 
think  that  its  use  would  be  particularly  beneficial  in  women  near 
the  forties,  and  especially  during  the  years  before  and  after  the 
climacteric  until  about  the  sixtieth  year.  According  to  Grawitz, 
arsenic  acts  better  than  iron  in  the  ansemia  of  the  aged. 

Arsenical  treatment  has  given  us  excellent  results  also  in 
nervous  troubles  of  women  at  a  much  earlier  age.  It  has  often 
produced  an  increase  in  the  weight  and  an  improvement  in  the 
personal  appearance  of  our  patients. 

As,  according  to  Gauthier1  and  Bertrand,  the  thyroid  gland 
contains  arsenic,  we  are  thus  administering  an  important  ele- 
ment of  this  gland.  The  observation  of  Dr.  Sajous2  is  of  great 
importance,  that  arsenic  dilates  the  arterioles.  Indeed,  we  have 
also  made  similar  observations ;  thus  we  found  after  the  use  of 
arsenic  in  several  cases  a  higher  vascular  pressure  and  irregulari- 
ties of  the  pulse  similar  to  those  occurring  after  tobacco  smoking, 
which,  as  shown  before,  has  also  a  stimulating  action  upon  the 
adrenals.  In  a  few  cases  there  was  also  pigmentation  of  the 
skin.  By  using  arsenic  while  taking  thyroid  extracts  we  stimu- 
late the  antagonists  of  the  thyroid,  the  adrenals;  and  thus  the 
symptoms  of  hyperthyroidia  can  be  avoided  by  simultaneously 
giving  arsenic  in  small  doses.  As  we  shall,  in  the  next  chapter, 
recommend  the  use  of  thyroid  extracts  in  the  prevention  of 
premature  old  age,  and  in  the  treatment  of  old  age,  this  simul- 
taneous use  of  arsenic  can  increase  the  benefit  of  such  treat- 
ment;   but  for  the  purpose  in  question  arsenic  should  be  given 


i  Revue  de  M£decine  Bulletin  Aeademie  de  Medecine,  vol.  xliii,  p.  116,  1900. 
2  Sajous:     "Internal  Secretions,"  vol.  ii,  p.  1312,  1907. 


428  Old  Age  Deferred. 


in  the  smallest  possible  doses,  as  Fowler's  solution,  beginning 
with  3  drops  and  increasing  to  not  more  than  5  or  6  drops  per 
day,  by  slow  and  gradual  degrees,  and  then  decreasing  slowly 
again,  but  not  for  longer  than  for  three  or  four  weeks  altogether. 
In  women  something  more  could  be  given.  Far  better  than 
Fowler's  solution  would  be  the  various  mineral  waters  that  con- 
tain the  most  useful  form  of  arsenic,  as  such  waters  usually  con- 
tain also  iron,  which  still  further  increases  their  value.  Such 
mineral  waters  can  be  found  in  various  countries,  viz. :  in  Aus- 
tria, in  the  Tyrol :  Levico,  very  rich  in  arsenic  and  iron,  and 
Roncegno,  rich  in  arsenic ;  in  Bosnia :  Guberquelle,  very  rich  in 
iron ;  in  Switzerland :  Val  Sinistra ;  in  France :  Royat,  Bour- 
boule,  etc.  They  are  absolutely  innocuous  if  taken  under  medical 
care.  We  must  begin  by  taking  one  tablespoonful  of  these 
arsenical  waters,  and  gradually  increase  to  five  or  six  tablespoon- 
fuls  a  day,  when  we  must  then  again  gradually  diminish  the 
amount. 

By  taking  such  waters,  increasing  slowly  and  gradually 
and  then  decreasing  in  a  similar  way,  the  most  efficacious  arsenic 
and  iron  treatment  can  be  obtained,  and  a  simultaneous  thyroid 
treatment  better  endured.  It  is  better  to  take  such  remedies 
after  meals,  and  the  patient  must  be  kept  under  constant  medical 
supervision,  just  as  they  are  during  iodine  or  thyroid  treatment. 

We  have  often  observed  that  women,  especially  in  the 
forties  or  fifties,  looked  much  younger  after  a  treatment  by  iron 
preparations,  particularly  when  in  combination  with  iron  and 
arsenic;  mineral  mud  baths,  containing  much  iron,  have  been 
used;  and  we  are  quite  emphatic  in  asserting  that  such  treat- 
ment, possibly  more  in  women  than  in  men,  though  in  these  we 
have  not  infrequently  noted  the  same  results,  is  able  to  improve 
the  symptoms  of  old  age;  for  we  have  had  opportunities  of 
observing  this  in  many  cases,  sometimes  even  in  women  at  the 
beginning  of  the  sixties. 

The  best  results  can  be  observed  in  women  between  30  and 
60,  even  though  they  sometimes  have  no  previous  anaemia,  who 


Prevention  of  Premature  Old  Age  Through  Drugs.     429 

look  much  healthier  after  such  a  combined  iron,  arsenic,  mineral 
water,  and  mud-bath  treatment.  In  men  similar  results  have 
been  noted;  but  in  the  case  of  women  it  must  be  regarded  as  a 
specific. 

In  the  same  way  as  iodides  act  on  the  thyroid,  we  are  in- 
clined to  think  that  arsenic  and  iron  are  specifics  to  promote  a 
better  action  of  the  sexual  glands,  especially  the  ovaries,  and 
probably  also  of  the  adrenals. 

According  to  Professor  von  Noorden3  and  other  authors, 
chlorosis  is  due  to  a  degenerated  condition  of  the  ovaries.  But 
the  adrenals  also  may  be  altered,  causing  the  great  muscular  weak- 
ness of  chlorotic  girls.  Thus  Dr.  Sajous4  has  attributed  chlo- 
rosis to  adrenal  degeneration.  If,  as  observed  for  centuries, 
arsenic  and  iron  are  specifics  in  augmenting  haemoglobin  in  the 
blood,  it  is  a  question  whether  this  effect  is  obtained  by  the  action 
of  these  preparations  upon  the  ovaries,  or  upon  the  adrenals,  as 
advocated  by  Dr.  Sajous.5  The  probability  is  that  they  act  upon 
both  glands.  Mud  baths  which  are  rich  in  iron  are  especially 
potent  and  successful  against  chlorosis  and  anaemic  conditions, 
and  at  the  same  time  against  ailments  of  the  ovaries  and  uterus, 
as  is  well  known  to  gynaecologists.  Iron  seems  also  to  exercise 
beneficent  action  on  the  male  sexual  glands.  Impotency,  as  we 
have  also  seen,  can  often  be  improved  by  iron  preparations,  or 
by  mineral  waters  containing  iron  and  arsenic.  Hysteria,  as 
ancient  physicians  supposed  it  to  be,  and  as  we  have  tried  to 
show,6  is  due,  in  great  probability,  very  frequently  to  alterations 
in  the  female  sexual  organs,  and  iron  treatment,  especially  arsenic 
and  iron  mineral  waters,  improves  many  cases. 

As  well  known  to  urologists,  the  general  condition  in  cases 
of  chronic  posterior  gonorrhoea,  and  in  prostate  troubles  from 


3  v.    IsToorden:      "Die    Bleichsucht"    Nothnagel's    "Handbuch     der    pract, 
Medicin." 

4  Sajous:     "Internal  Secretions,"  vol.  i,  p.  87,  Philadelphia,  1903. 

5  Loc.  cit.,  p.  95. 

6  Congress  of  Belgian  Neurologists,  1906. 


430  Old  Age  Deferred. 


such  a  cause,  is  often  improved  through  iron  treatment;  as  also 
is  neurasthenia,  even  though  some  cases  are  not  in  etiological 
relation  with  such  a  cause. 

We  must  thus  consider  iron,  especially  when  in  combination 
with  arsenic,  as  one  means  of  improving  the  condition  of  the 
sexual  organs  judging  from  the  foregoing  reported  clinical 
observations.  The  fact  that  iron  of  itself  is  no  longer  regarded 
as  being  useful  in  senility — i.e.,  when  the  sexual  glands  are  more 
or  less  degenerated — points  to  the  value  of  its  combination  with 
arsenic.  We  consider  iron,  especially  in  the  form  of  the  easily 
absorbed  iron  mineral  waters,  and  in  the  form  of  the  iron  con- 
tained in  mud  baths,  as  a  valuable  means  for  the  prevention 
of  premature  old  age,  and  for  the  treatment  of  old  age.  Iron, 
and  especially  inorganic  iron,  is  indicated  as  a  preventive  of  old 
age  for  the  reason  that  it  stimulates  to  greater  activity  the  blood 
forming  organs,  as  has  been  shown  by  Harnack  and  von 
Noorden.  It  is  a  fact,  upon  which  we  have  already  insisted,  that 
the  organs  which  control  the  condition  of  the  bone  marrow,  the 
seat  of  the  blood  forming  mechanism — i.e.,  the  thyroid  and  the 
ovaries, — are  degenerated  in  old  age.  Iron  acts  upon  the  bone 
marrow  through  the  intermediate  agency  of  these  glandular 
structures. 

It  can  be  administered  in  the  form  of  the  perchloride  or  of 
other  inorganic  preparations.  According  to  Bunge,  organic  iron 
preparations  and  iron  contained  in  food  have  the  advantage  of 
being  more  readily  absorbed  and  assimilated.  (See  chapter  on 
the  blood  as  an  article  of  iron-containing  food.)  But  Grawitz 
still  prefers  to  prescribe  inorganic  iron,  such  as  reduced  iron  or 
perchloride  of  iron.  An  old  iron  preparation  of  great  efficacy  is 
the  Blaud  pills. 

A  very  successful  method  of  iron  treatment  is  by  mineral 
waters  which  are  rich  in  iron — in  Austria,  Franzersbad;  in 
Germany,  Langenswalbach.  We  prefer  such  waters  as  contain 
arsenic  besides  iron,  as  already  mentioned. 

When  mud  baths  are  used  simultaneously,  it  will  be  advis- 


Prevention  of  Premature  Old  Age  Through  Drugs.     431 

able  not  to  take  thyroid  extracts  also ;  but  to  await  doing  so  till 
after  the  course  of  baths  is  finished. 

Increase  of  fat  and  of  connective  tissue  are  the  most  typical 
and  anatomo-pathological  changes  in  the  tissues  produced  by 
old  age.  It  is  evident  that  drugs  which  can  combat  these 
changes  are  also  able  to  treat  and  improve  the  condition  of  old 
age.  There  is  no  inorganic  drug  which  can  give  such  good 
results  in  these  conditions,  according  to  our  present  knowledge, 
as  the  iodides.  It  is  generally  believed  that  through  the  use  of 
potassium  iodide  we  are  able  to  diminish  fat  in  many  cases.  The 
increase  of  connective  tissue  in  different  organs,  that  takes  place 
in  the  cirrhosis  of  these  organs,  has  also  been  treated  by  iodides 
with  success,  according  to  some  authorities,  and,  according  to 
others,  without  any.  At  any  rate,  in  arteriosclerosis  there  can  be 
no  doubt  that  iodides  do  give  good  results  as  they  facilitate  the 
circulation  of  the  blood  by  diminishing  its  viscosity.  According 
to  Heinz,7  iodides  can  combat  connective  tissue  hypertrophy  by 
rendering  the  vessel  walls  more  permeable.  They  also  increase 
the  activity  of  the  leucocytes. 

When  we  administer  iodides  we  give  in  them  the  main  ele- 
ment of  the  thyroid  gland — iodine,  so  that  iodide  treatment  acts 
on  these  glands  and  increases  their  iodine  contents.  Iodine  is  a 
rational  remedy  for  preventing  old  age,  for  the  reason  that,  as 
Baumann  and  Jollin  have  found,  the  thyroid  gland  of  aged 
persons  contains  but  little  iodine.  We  know,  through  the 
researches  of  Blum,  Baumann,  Kocher,  Aeschbacher,  etc.,  that 
by  administering  iodide  we  increase  not  only  the  iodine  content 
of  the  thyroid,  but  also,  as  the  experiments  of  Gamier  show,  its 
colloid  substance.  Iodides  are  best  taken  in  the  form  of  a 
saturated  solution  of  sodium  iodide,  or  other  preparations  con- 
taining this  salt.  They  act  best  when  taken  in  small  quantities 
(not  over  15  grains  of  the  iodide  a  day),  such  amounts  stimulat- 
ing thyroid  activity ;  larger  doses,  by  overstimulating,  may  cause 
a  subsequent  exhaustion  of  the  thyroid. 
7 Heinz:     Virchow's  Archiv,  civ,  p.  44. 


432  Old  Age  Deferred. 


That  iodide  treatment  is  able  to  increase  thyroid  activity 
is  best  shown  by  the  fact  that  it  may  be  followed  by  iodism, 
which  presents  most  of  the  symptoms  that  follow  large  doses  of 
thyroid  extracts.  It  is  very  probable  that  many  benefits  obtained 
by  iodide  treatment  can  be  explained  through  its  action  in 
increasing  thyroid  activity. 

Instead  of  using  inorganic  iodine,  it  would  seem  more  log- 
ical to  use  organic  iodine,  as  contained  in  the  thyroid  gland.  We 
could  thereby,  to  a  certain  extent,  replace  iodides  successfully  by 
thyroid  extracts;  the  drawback,  however,  is  that  some  thyroid 
preparations  contain  only  a  minimum  quantity  of  iodine,  while 
others  contain  more.  It  would,  therefore,  be  advisable,  when 
thyroid  extracts  are  used,  which  contain  only  a  very  little  iodine, 
to  use  in  combination  therewith,  very  small  quantities  of  iodide  of 
potassium ;  say,  one  day  one  or  two  thyroid  tablets,  and  the  next 
day  the  iodide.  It  is  best,  when  we  are  trying  to  treat  the  symp- 
toms of  senility  by  combined  iodide  and  thyroid  preparations,  to 
feel  our  way  very  cautiously,  every  third  day  examining  the 
heart  and  pulse  (see  following  chapter). 

Such  treatment  should  be  undertaken  only  when  a  thor- 
ough knowledge  is  possessed  of  the  physiology  and  pathology 
of  the  thyroid  gland. 

The  fact  that  iodides  improve  the  circulation  of  the  Wood 
makes  them,  in  old  age,  especially  useful,  as  arteriosclerosis  is 
then  very  frequent  and  the  iodides  become  of  special  value. 
Similar  remedies  are  also  indicated  in  all  conditions  arising  from 
tertiary  syphilis,  which  is  very  often  a  cause  of  premature 
senility.  For  all  the  reasons  given  above  we  think  that  iodide 
treatment,  in  small  doses,  especially  in  combination  with  thyroid 
treatment,  can  give  good  results  in  our  struggles  against  old  age, 
and  in  its  treatment  when  it  has  advanced  on  us. 

We  have  often  observed  that  old  people  taking  iodides 
for  arteriosclerosis,  present  a  much  more  youthful  appear- 
ance after  such  treatment ;  and  Dr.  G.  W.  Gibson,  physician  of 
the  Royal  Infirmary  in  Edinburgh,  tells  us  that  he  has  observed 


Prevention  of  Premature  Old  Age  Through  Drugs.      433 

the  same  thing.  We  might  especially  mention  the  case  of  an 
English  gentleman  58  years  of  age,  who  had  six  years  ago  a 
hemorrhage  in  the  right  eye;  since  that  time  he  has  been  taking 
iodides,  and  in  spite  of  his  age  is  looking  quite  fresh  and  youthful 
— indeed,  he  recently  married  a  young  lady  of  18  years. 


CHAPTER  LVI. 

On  the  Prevention  of  Premature  Old  Age  and  on  the 
Treatment  of  Old  Age  by  Animal  Extracts. 

When,  some  twenty-two  years  or  more  ago,  the  first  ac- 
counts came  to  hand  of  the  marvelous  effects  of  extracts  from 
the  thyroid  gland  of  sheep,  they  were  at  first  received,  as  in 
general  are  all  reports  about  wonderful  cures,  with  incredulity 
or  scepticism ;  and  it  is  quite  possible  that  the  same  might  be  the 
case  regarding  the  success  of  our  method  of  treating  the  symp- 
toms of  old  age,  and  the  prevention  of  their  premature  develop- 
ment, by  thyroid  and  other  organic  extracts,  were  it  not  that 
we  are  supported  by  a  mass  of  evidence,  to  which  we  will  at 
once  refer. 

It  has  been  noticed  by  all  the  leading  investigators  on  the 
effects  of  thyroid  extracts,  such  as  G.  Murray,1  Hector  Mac- 
kenzie,2 Hertoghe,3  and  others,  that  the  majority  of  old  people 
treated  for  myxcedema  by  thyroid  extracts,  after  a  certain  period 
of  treatment,  presented  a  much  younger  appearance,  sometimes 
even  to  the  extent  of  from  ten  to  twenty  years.  This  fact  is 
perfectly  true,  as  we  can  see  from  the  photographs  of  these  cases, 
taken  before  and  after  treatment,  by  Murray,  Laache,4  Oppen- 
heim,5  Ewald,5a  Hertoghe,  and  many  others ;  the  greater  number 
of  these  photographs  show  persons  looking  very  much  younger 
after  but  a  few  months',  and  in  some  instances  less,  treatment. 
Several  of  the  above-mentioned  authorities,  and  also  Vermehren6 


i  Murray:    "Diseases  of  the  Thyroid  Gland,"  vol.  i,  London,  1901. 

2  Mackenzie:     British  Med.  Journal,  Oct.  29,  1892. 

3  Hertoghe :     Loc.  cit. 

4  Laache:    Deutsche  Med.  Wochenschrift,  1893. 
sOppenheim:    Lehrbuch  der  Nervenkrankheiten,  Nu.  ii,  p.  1390. 
5aEwald:     "Die  Erkrankimgen   der   Schilddriise,"   second   edition,    1909. 
6  Vermehren :     Loc.  cit. 

(434) 


Prevention  of  Premature  Old  Age  by  Animal  Extracts.    ^'■''■'> 

and  others,  report  that  dark  hair  has  grown  on  places  which, 
before  the  treatment,  were  bare,  and  where  previously  gray  hair 
had  fallen  off.  This  would  appear  incredible  were  it  not  a  fact, 
familiar  to  all  who  are  in  the  habit  of  prescribing,  in  many  cases, 
treatment  by  thyroid  extracts.  • 

Similar  facts  have  been  observed  by  us  personally  in  a 
number  of  cases,  among  them  two,  of  a  very  interesting  char- 
acter, in  the  wards  of  Dr.  Hector  Mackenzie,  at  St.  Thomas's 
Hospital,  in  London.  One  was  a  woman  of  65,  who  looked 
more  like  42  after  several  years'  treatment  with  thyroid  ex- 
tracts; the  other  was  a  woman  of  42  who,  as  it  seemed  to  me, 
looked  quite  ten  years  younger  after  taking  daily  one  thyroid 
tablet  for  twelve  months.  About  2  years  ago  we  saw  in  the 
wards  of  Dr.  G.  A.  Gibson,  at  the  Glasgow  Royal  Infirmary,  a 
woman  of  72  who,  after  a  similar  treatment  during  the  past 
twenty  years,  looked,  as  we  agreed  with  Dr.  Gibson,  only  between 
50  and  60.  Most  of  the  above  cases  were  those  of  persons  suf- 
fering from  myxcedema ;  so  the  question  arises  whether  all  other 
people,  not  affected  with  this  complaint  to  the  same  extent,  may 
not  also  derive  equal  benefit  from  a  similar  treatment. 

We  have  shown  in  several  chapters  of  this  book  that  in 
old  age  the  iodine  content  of  the  thyroid  gland  is  much  dimin- 
ished and  the  tissue  of  the  gland  itself  is  degenerated  in  varying 
degrees,  at  times  approximating  to  myxcedema ;  and,  as  found 
also  by  Sir  Victor  Horsley,  Hale  White,  Vermehren,  Ewald,  and 
ourselves,  old  age  presents  clinical  symptoms  similar  to  those  of 
myxcedema. 

Naturally  not  every  old  man  has  the  whole  thyroid  gland 
degenerated,  and  clinically,  therefore,  there  will  be  varying  de- 
grees in  the  myxedematous  conditions,  some  presenting  more 
and  some  less  of  the  symptoms ;  so  that  some  men  of  80  years 
of  age  may  look  younger  than  others  at  65  or  70. 

If  a  man  of  60,  suffering  from  absolute  myxcedema,  that 
is,  a  complete  degeneration  of  the  thyroid  gland,  will  present  an 
appearance  of  50  or  less,  after  thyroid  treatment,  as  shown  in  the 


436  Old  Age  Deferred. 


photographs  of  the  above  mentioned  authorities,  and  as  seen  by 
ourselves,  why  should  another  man  of  60,  having  only  partial 
symptoms  of  this  complaint,  as  usual  at  this  age,  not  benefit  to 
the  same  extent  and  look  younger  after  similar  treatment?  It 
would  be  quite  adverse  to  all  notions  of  pathology  for  a  man, 
in  a  better  condition  of  general  health  and  suffering  only  from 
a  mitigated  and  partial  form  of  a  disease,  not  to  derive  equal  or 
greater  benefit  from  a  similar  treatment  as  the  other  person  of  the 
same  age  affected  by  a  complete  development  and  thus  increased 
degree  of  the  same  disease.  This,  indeed,  would  be  contrary  to 
all  sound  reasoning. 

But  we  have  had  personal  opportunities  of  treating  numer- 
ous persons,  not  actually  myxedematous,  but  exhibiting  only 
slight  symptoms  of  such  a  condition,  such  as  are  found  in  people 
with  premature  senility,  and  also  in  many  cases  of  obesity  and 
arteriosclerosis,  and  in  every  case  we  have  been  able  to  observe 
a  more  youthful  appearance  afterward. 

The  features  have  become  notably  more  refined  and  more 
sharply  defined,  and  there  were  many  other  benefits  that  may 
often  follow  thyroid  treatment,  such  as  loss  of  excessive  weight,  in- 
creased quantity  of  urine  and  of  perspiration,  and  better  action 
of  the  intestines.  The  gait  especially  became  much  easier;  some 
were  able  to  climb  hills,  whereas  prior  to  the  treatment  they 
became  fatigued  from  less  than  a  ten  minutes  walk.  The 
improvement  in  the  mental  condition  was  sometimes  striking; 
memory  especially  became  much  better,  as  did  also  the  general 
intelligence.  It  was  also1  very  interesting  to  note  that  abrasions, 
or  any  kind  of  sores,  healed  rapidly  with  fine  granulations;  for 
which  reason  such  a  treatment  may  give  good  results  also  in  leg 
ulcers.  We  have  obtained  the  best  results  from  our  thyroid 
treatment  in  those  persons  who  were  prematurely  ageing;  but 
even  in  the  aged  we  have  produced  an  improvement  in  the 
symptoms. 

By  the  amelioration  of  the  functions  of  the  skin,  kidneys, 
and  intestines,  which  functions  are,  as  a  rule,  impaired  in  old 


Prevention  of  Premature  Old  Age  by  Animal  Extracts.    437 

age,  such  treatment  may  already  be  indicated;  and  especially 
since  the  production  of  heat  is  thereby  augmented,  which  is  a 
great  advantage  to  old  people,  who  usually  complain  of  cold. 
At  the  same  time  we  are  able  to  increase  the  processes  of  oxida- 
tion, which  are,  as  already  mentioned,  diminished  in  old  age. 
Thus,  from  the  improvement  in  all  these  functions  from  the  ad- 
ministration of  thyroid  extracts  in  old  age,  the  treatment  is,  prima 
facie,  justified.  Great  care  must,  however,  be  exercised  in  pre- 
scribing such  extracts,  and  they  should  never  be  given  unless  the 
effects  on  the  patient  can  be  properly  observed  every  three  or  four 
days,  as  all  the  drugs  which  are  as  effective  as  the  thyroid,  such 
as  arsenic  or  other  active  drugs,  can  do  much  mischief  if  taken 
in  large  quantities.  For  such,  so  to  say,  physiological  purposes 
as  we  are  required  to  give  them,  thyroid  extracts  should  be  ad- 
ministered in  a  quantity  just  sufficient  to  make  up  the  amount  of 
thyroid  secretion  which  the  body  demands ;  the  greater  the  age, 
the  larger  the  dose ;  but  we  must  not  forget  that,  as  in  advanced 
cases  of  myxcedema,  so  also  in  advanced  senility,  we  must  not 
expect  too  great  results  from  the  treatment.  The  thyroid 
extracts  that  we  give  can  only  act  if  the  thyroid  gland  still  has 
some  of  its  secreting  structure  intact  and  is  not  yet  completely 
degenerated,  which  latter  is  the  case  in  complete  myxcedema  and 
advanced  senility.  It  is  best  to  commence  at  about  40,  and  in 
persons  with  symptoms  of  premature  senility,  even  before  this. 
Simultaneous  obesity  will  offer  the  best  opportunity  for  this 
treatment,  and  by  the  mere  reduction  of  superfluous  fat  a  more 
youthful  appearance  may  be  obtained.  In  younger  people,  about 
or  prior  to  middle  age,  one  tablet  daily,  or  sometimes  two  for  a 
week  or  so,  then  going  back  to  one  a  day,  will  be  the  best  method. 
It  also  is  necessary  to  have  free  intervals  of  five  or  six  days 
between  treatments,  and  then  to  commence  de  novo.  We  must 
bear  in  mind  that  the  effects  of  the  thyroid  gland  may  be 
cumulative. 

From  observations  on  ourselves  and  on  patients  we  recom- 
mend for  such  as  are  not  advanced  in  age,  say,  below  40  or  45, 


438  Old  Age  Deferred. 


one  tablet  for  a  week  or  two,  then  stop  for  a  few  days,  resuming 
with  one  tablet  for  a  week;  then  an  interval  of  three  days  be- 
fore commencing  again ;  while  for  those  with  symptoms  of  prema- 
ture senility  two  or  more  tablets  could  be  given,  proceeding  as 
above.  In  more  advanced  age  two  or  three  tablets  may  be  given 
for  two,  three  or  four  weeks  before  a  free  interval  of  several 
days  takes  place. 

We  must  emphasize  the  fact,  however,  that  a  physician  who 
prescribes  such  extracts,  should  have  a  thorough  knowledge  of 
the  physiology  and  pathology  of  the  thyroid  gland  for  his  safe 
guidance.  On  the  other  hand,  we  again  urge  that  patients  should 
never  use  them  otherwise  than  under  the  guidance  of  a  physician. 

When  thyroid  is  taken  in  an  irrational  way  in  large  doses,  or 
when  continued  for  too  long  a  time,  we  may  sometimes  have  the 
very  opposite  symptoms  for  a  time — even  more  fat,  and  in  some 
cases  older  looks ;  but  if  we  abandon  the  treatment  for  two  or 
three  weeks  we  may  witness,  as  we  ourselves  have  done,  a  general 
improvement  in  the  condition  and  personal  appearance ;  after 
iodide  treatment  we  may  observe  the  same,  sometimes  with  in- 
crease of  fat.  Thyroid  extracts  cause  a  greater  activity  of  the 
thyroid,  and  at  times  even  an  over-activity — thyroidism — which 
may  be  followed  by  its  exhaustion.  This  has  been  proved  by 
experiments  by  Christiani,  who  transplanted  a  fresh  thyroid 
gland  on  an  animal  with  healthy  thyroid,  and  thereby  produced 
a  degeneration  of  the  latter.  Walter  Edmunds,  by  feeding 
monkeys  and  dogs  on  too  large  a  quantity  of  thyroid  extract, 
produced  in  their  central  nervous  systems  changes  similar  to 
those  following  extirpation  of  the  thyroid  gland.  Much  iodide 
of  potassium  is  apt  to  produce,  not  only  a  diminution  in  size 
of  the  thyroid,  but  sometimes  its  degeneration  (see  Gamier, 
Chapter  III).  As  we  have  observed,  the  symptoms  of  exhaus- 
tion of  the  thyroid  after  thyroid  treatment  are,  as  a  rule,  merely 
temporary,  and  may  pass  off  after  a  rest  of  a  week  or  so ;  but  yet 
we  must  sound  a  warning  against  hasty  and  imprudent  treatment. 

7  hoc,  cit. 


Prevention  of  Premature  Old  Age  by  Animal  Extracts.    439 

These  extracts  contain  more  or  less  iodine  according  to 
their  manufacture;  and  it  has  been  shown  by  Claude  Bernard 
that  iodine  is  not  easily  eliminated  from  the  body,  but  is  retained 
for  a  given  time;  so  that  the  effects  of  the  treatment  may  be 
felt  also  in  the  free  interval,  and  according  to  our  observations, 
often  better  then  than  during  actual  treatment.  Taking  the  ex- 
tracts for  too  long  a  time  without  intervals  may,  at  times,  pro- 
duce disagreeable  symptoms,  such  as  palpitation  of  the  heart, 
nervous  excitability,  sleeplessness,  etc. ;  so  that  during  the  course 
of  the  treatment  the  patient  should  be  examined  every  three  or 
four  days  as  to  the  condition  of  the  heart  and  urine ;  and  if  the 
pulse  rises  above  90,  if  it  were  lower  before,  the  treatment  should 
be  suspended  for  a  few  days;  much  meat,  alcohol,  strong  tea  or 
coffee,  should  be  avoided.  When  thyroid  extract  in  large  doses 
and  much  meat  are  taken  together,  according  to  our  observation 
in  a  few  cases,  traces  of  sugar  may  appear  in  the  urine  up  to,  say, 
from  0.1  per  cent,  to  0.4  per  cent.,  which  quickly  disappear  if 
the  meat  is  reduced,  in  spite  of  continuing  the  thyroid  cure,  as 
we  have  noted  in  two  cases.  It  is,  of  course,  well  understood  that 
thyroid  treatment  should  not  be  tried  in  patients  who  show 
symptoms  of  a  hyperactive  condition  of  the  thyroid  gland — e.g., 
a  rapid  heart  action,  etc. ;  but  we  must  rather  try  to  improve  only 
a  deficient  activity  of  the  thyroid  gland.  By  giving  small  quanti- 
ties of  iodides  before  beginning  thyroid  treatment  we  could  best 
ascertain  the  condition  of  the  thyroid  gland ;  for  if  symptoms  of 
iodism  appeared  we  would  then  be  in  the  presence  of  a  very 
active  thyroid,  and  thyroid  treatment  would  be  contraindicated. 
In  many  cases  of  inactivity  of  the  thyroid  gland  we  have  obtained 
excellent  results  by  administering  simultaneously  thyroid  prepara- 
tions and  small  quantities  of  iodides.  The  use  of  stimulants 
such  as  alcohol,  strong  tobacco,  and  strong  tea  or  coffee,  should 
be  forbidden  during  thyroid  treatment. 

Taken  in  the  above  manner  with  the  necessary  precautions 
and  only  under  medical  supervision,  thyroid  as  a  preventive  for 
premature  senility,  and  as  a  treatment  for  the  symptoms  of  senility, 


440  Old  Age  Deferred. 


is  entirely  harmless.  We  have  never  observed  the  least  incon- 
venience in  any  of  the  numerous  cases  we  have  treated  when 
our  instructions  as  to  doses  and  diet  were  carried  out,  nor  in 
ourselves.  We  have  personally,  for  experimental  purposes, 
taken  these  extracts  for  the  past  five  years — once  for  ten  months 
with  short  intervals — and  stood  it  very  well.  Sometimes  a  few 
occasional  pimples  were  seen,  and  sometimes  sore  throat 
developed,  and  in  some  patients  headache.  It  is  essential  that 
only  fresh  preparations  from  a  reliable  source  should  be  used. 

The  effects  of  these  extracts  on  the  nervous  system  and 
mentality  are  very  remarkable.  As  already  mentioned,  we  noted 
greater  immunity  from  fatigue,  bodily  and  mental,  in  many  pa- 
tients, and  also  in  ourselves.  Memory  seems  to  have  been  much 
improved. 

The  same  has  also  been  noted  by  Hertoghe,  who  told  us  that 
he  used  to  take  three  tablets  immediately  before  beginning  his 
lectures.  We  do  not  think  it  advisable  to  exceed  two  or  three 
tablets  a  day ;  and  even  then  it  is  best  not  to  take  this  quantity,  as 
a  general  rule,  for  longer  than  one  week,  when  we  must  then 
reduce  this  quantity  to  one  tablet. 

In  combination  with  thyroid  extracts  or  alone,  ovarian  ex- 
tracts have  given  us  favorable  results  in  the  treatment  of  aged 
women,  and  also  in  younger  ones  before  the  menopause,  espe- 
cially after  oophorectomy.  Obesity  that  follows  the  menopause, 
or  the  degeneration  or  extirpation  of  the  ovaries,  and  which 
may  also  be  regarded  as  one  of  the  primary  symptoms  of  old 
age,  has  been  in  nearly  every  case  very  favorably  influenced  by 
ovarian  extracts,  particularly  in  such  cases  as  thyroid  extracts 
were  used  at  the  same  time. 

A    very    interesting    case    is    mentioned    by    Burghart8    of 
obesity  in  a  young  woman  of  20,  consequent  to  an  undeveloped 
condition  of  the  ovaries  and  uterus.     By  giving  ovarian  extracts 
he  was  able  to  reduce  the  weight  by  8  kilos,  and  when  the  treat-  ' 
ment  was  discontinued,  obesity  returned. 

8  Burghart:    Deutsche  Med.  Wochenschrift,  p.  610  and  627,  1899, 


Prevention  of  Premature  Old  Age  by  Animal  Extracts.    441 

As  we  have  already  shown,  the  ovaries  also  influence  the 
processes  of  oxidation.  Loewy  and  Richter  were  able  to  con- 
siderably increase  oxidation  in  animals  by  ovarian  extracts. 
Very  important  also  is  the  fact  that  Spillman  and  Etienne9  ob- 
served an  increase  in  the  number  of  red  blood-corpuscles  after 
ovarian  treatment.  For  the  above  reasons  alone,  ovarian  extracts 
should  be  tried  in  old  age,  where  we  find,  as  already  stated,  a 
diminution  of  oxidation,  and  very  frequently  also,  in  old  women, 
an  anaemic  condition.  Chroback  and  Landau  were  the  first  to 
employ  with  good  results  ovarian  preparations  for  the  relief  of 
the  symptoms  following  castration  in  women.  According  to  our 
observations  on  many  women  under  our  care,  the  greatest  benefit 
can  be  afforded  by  ovarian  treatment  to  cases  having  the  disagree- 
able nervous  disorders  which  follow  the  menopause,  such  as  hot 
flushes,  nervous  depression,  headaches,  nervous  insomnia,  etc., 
these  symptoms  having  disappeared  in  nearly  every  case  after 
several  weeks'  treatment. 

We  consider  ovarian  extracts  to  be  a  specific  against  the 
painful  feelings  of  heat  in  women  in  the  years  succeeding  the 
menopause,  or  after  oophorectomy  in  younger  years.  In  order  that 
these  extracts  should  be  active,  it  is  necessary  that  they  should 
be  prepared  from  the  corpus  luteum  part  of  the  ovaries,  which 
contains  their  internal  secretions.  The  pig  would  be  the  best 
animal  for  the  purpose,  for  its  ovaries  have  been  found  supe- 
rior to  those  of  other  animals ;  and  they  also  contain  more  iodine, 
much  more  than  the  ovaries  of  cattle. 

When  prescribing  ovarian  extracts  we  may  give  larger 
doses  than  of  thyroid  extracts,  as  they  are  less  dangerous  when 
taken  in  large  quantities  than  the  latter.  We  usually  begin  with 
two  tablets,  increasing  to  four,  a  day. 

Less  active  than  the  ovarian  preparations  are  the  extracts 
of  the  testicles,  at  least  in  the  form  in  which  they  are  at  present 
used.     It  is  very  probable  that  this  may  be  due  to  the  testicles  of 


9  Spillman  and  Etienne :    C.  E.  du  Congres  de  Medecine  de  Nancy,  p.  953, 
1896. 


442  Old  Age  Deferred. 


bulls  being  mainly  used  up  to  now,  for  just  as  their  ovaries  are,  so 
also  may  the  testicles  of  cattle  be  less  efficacious.  In  addition  it 
is  also  probable  that  these  extracts  do  not  contain  certain  effective 
parts  of  the  testicles.  It  has  been  demonstrated  by  several  au- 
thorities, as  Shattock  and  Seeligmann,10  Ansele,  and  Bouin,  that 
the  internal  secretion  of  the  testicles  is  derived,  to  a  certain  extent, 
from  the  interstitial  cells,  a  group  of  cells  imbedded  in  the  spaces 
between  the  individual  tubules.  In  some  animals,  as  in  the  pig,  as 
found  by  Shattock,  these  cells  are  contained  in  such  amount  that 
they  form  a  special  part  of  the  testicles  called  by  Shattock  "para- 
tubular  glands;"11  and  for  this  reason  alone  pigs'  testicles  should 
be  preferred.  It  seems  that  the  interstitial  cells  can  only  play  a 
role  in  combination  with  certain  other  parts  of  the  male  sexual 
organs,  for  certainly  when  alone  they  cannot  represent  the  part 
of  the  testicles  which  gives  the  real  internal  secretion.  This  is 
shown  by  the  fact  that  they  are  found  in  the  largest  number  in 
degenerated  conditions  of  the  testicles — for  example :  in  cretins 
(Lanz),  in  undescended  testicles  (Bellingham  Smith),  and  in 
atrophied  testicles  of  old  men  (Haviero  Spangaro12). 

That  testicular  extracts  are  able  to  improve  the  symptoms 
of  senility  has  been  shown  by  the  celebrated  physiologist,  Brown- 
Sequard,13  from  experiments  on  himself.  He  used  an  extract 
prepared  from  the  crushed  testicles  of  guinea-pigs  or  dogs. 
After  injecting  these  extracts  into  his  arms  and  le'gs,  this  old 
savant  of  72  noted  a  considerable  increase  in  his  muscular  and 
mental  powers.  As  he  mentioned  in  his  communication  to  the 
Paris  Biological  Society,  he  observed  in  himself  an  augmentation 
of  the  energies  of  the  nervous  centers;  he  found  that  he  could 
do  more  work  than  formerly,  and  that  without  getting  tired  he 
could  more  easily  ascend  the  staircase,  nearly  running,  just  as  he 
used  to  do  until  he  was  60 ;  and  by  the  dynamometer  he  noticed  a 

10  Shattock  and  Seeligmann :     Transactions  of  the  London  Path.  Society, 
p.  57,  vol.  Ivi. 

11  Shattock:     Loc.  cit. 

12  Spangaro :    Anatomische  Hefte,  Wiesbaden,  vol.  Ix,  1902. 

13  C.  R.  de  la  Societe"  de  biologie,  1  and  15,  Juin,  1889. 


Prevention  of  Premature  Old  Age  by  Animal  Extracts.   443 

decided  increase  in  the  muscular  power  of  his  extremities.  All 
his  excretory  functions  were  improved;  he  had  laxative  action  of 
the  bowels  without  resorting  to  purges  to  the  same  degree  as 
formerly;  his  stream  of  urine  became  much  longer,  thus  indicat- 
ing a  better  muscular  power  in  the  urethra ;  he  could  work 
standing  for  a  few  hours,  whereas  before  he  was  always  obliged 
to  be  seated ;  and  he  found  that  his  intellectual  powers  increased 
considerably. 

It  is  almost  unnecessary  to  add  that  this  startling  commu- 
nication was  received,  in  spite  of  his  great  fame,  with  scepticism, 
and  by  many  even  with  derision.  And  yet  it  is  these  discoveries 
by  Brown-Sequard  that  have  laid  the  foundation  of  our  present 
knowledge  of  the  internal  secretions.  That  the  effects  were  not 
clue  to  auto-suggestion  has  been  shown  by  the  experiments  of 
Zoth  and  Pregl,14  who  found,  by  means  of  Mosso's  ergograph, 
an  increase  of  muscular  power  through  the  injection  of  testicular 
extracts.  It  is  also  very  interesting  to  note  that  in  a  few  diseases 
which  usually  occur  only  in  advanced  age,  testicular  extracts  have 
given  good  results,  such  as  in  Parkinson's  disease  and  in  tabes 
dorsalis,  as  shown  in  the  communications  of  Brown-Sequard  and 
D'Arsonval  to  the  Paris  Biological  Society  in  1892. 

We  have  also,  for  experimental  purposes,  tried  on  ourselves 
testicular  extracts  from  the  pig,  and  indeed  we  found  a  decided  in- 
crease in  muscular  and  mental  powers.  Thus  we  were  able  to 
climb  the  highest  hills  much  more  quickly  and  with  much  less 
fatigue  than  before ;  and  we  made  the  same  observation  in  regard 
to  increased  mental  activity;  and  we  must  strictly  defend  our- 
selves from  any  suspicion  of  having  been  influenced  by  auto- 
suggestion, which  is  not  to  be  inferred  after  similar  observations 
of  other  authorities.  Similar  results  we  have  personally  ob- 
served after  injection  of  spermin  (Poehl).  This  substance,  ob- 
tained from  the  testicles  of  animals,  was  introduced  by  Prof, 
v.   Poehl,15  of  St.   Petersburg,  and  has  been  commented  upon 


H  Pfliiger's  Archiv.  vol.  vi,  pp.  335  and  379,  1896. 

15  Poehl  and  Tarchanoff:    Organotherapie,  vol.  i,  St.  Petersburg. 


444  Old  Age  Deferred. 


by  many  authorities,  among  them  Professor  Senator  and  P.  F. 
Richter.  According  to  Poehl  it  advances  all  the  processes  of 
oxidation  in  the  tissues,  as  is  shown  also  by  the  experiments  of 
other  authorities — for  instance,  Prof.  Tarchanoff,  Prof.  Loewy, 
Richter,16  etc. — who  found  that  it  is  able  also  to  powerfully 
alkalinize  the  blood.  It  has  been  proved  by  a  mass  of  experi- 
mental evidence  that  spermin  is  a  catalytic  ferment,  and  that 
it  regulates  tissue  oxidation.  Poehl  insists  that  the  diminu- 
tion of  alkalinity  of  the  blood  may  also  reduce  the  resistance  of 
the  body  to  infection,  a  fact  fully  sustained  by  the  theory  of  Dr. 
Sajous,17  that  immunity  is  influenced  by  alkalinity;  and  it  is 
probably  due  to  this  that  many  authorities  have  obtained  good 
results  from  spermin  treatment  in  various  infectious  diseases  and 
in  conditions  of  autointoxication.  Loewy  and  P.  F.  Richter 
found  that  spermin  increases  hyperleucocytosis  and  the  alkalinity 
of  the  blood.  The  same  effects  have  been  claimed  by  Brown- 
Sequard  and  D'Arsonval  for  testicular  extracts.  They  reported 
cases  of  successful  cures  in  tuberculosis,  and  Ouspenski18  has 
successfully  treated  Asiatic  cholera  with  them. 

In  the  experiments  made  by  Loewy  and  Richter,  at  the 
suggestion  of  Professor  Senator,  on  animals,  it  was  found 
that  experimental  diseases,  such  as  pneumonia,  terminated  much 
better  after  an  injection  of  spermin  (see,  also,  Chapter  III). 

As  found  by  Bukojemsky,19  Hirsch,  etc.,  spermin  treatment 
has  given  good  results  in  senile  marasmus;  and  senile  pruritus 
can  be  improved  by  it,  as  stated  in  two  cases  by  Bosse.20  Very 
interesting,  also,  are  this  latter  savant's  observations  in  a  case  of 
optic  atrophy  due  to  syphilis,  when  spermin  was  used.  The 
patient  was  nearly  blind,  and  after  sixteen  injections  of  spermin 
he  could  again  see  the  hands  of  a  watch. 

Spermin  is  contained  in  different  organs,  especially  in  the 

16  P.  F.  Richter :     Organotherapie,  Berlin. 

17  Sajous :     "Internal  Secretions." 

18  C.  R.  Soc.  de  biologie,  Nov.  5,  1892. 

19  Petersburg!!  Med.  Wochenschrift,  Nu.  7,  p.  67,  1904. 

20  Journal  fur  wed.  Chemie  u,  Pharm.,  Dec,  1892, 


Prevention  of  Premature  Old  Age  by  Animal  Extracts.    445 

ductless  glands;  and  among  these  the  testicles  are  naturally  the 
richest  in  such  a  secretion.  In  order  to  obtain  the  best  testicular 
preparation,  the  whole  substance  of  the  testicles  must  be  taken, 
together  with  the  interstitial  cells,  and  not  the  latter  only. 
Brown-Sequard  prepared  his  extracts  from  guinea-pigs  and 
dogs,  which  do  not  have  a  large  number  of  these  cells.  We 
should  like  to  take  into  consideration  the  discovery  of  Professor 
Lanz,  who  found  in  the  testicles  of  impotent  cretins  a  large 
quantity  of  interstitial  cells ;  yet  neither  the  physical  nor  mental 
condition  of  cretins  permit  the  inference  of  very  active  sexual 
glands. 

In  our  opinion,  the  most  active  testicular  extracts  would  be 
those  derived  from  the  testes  of  the  pig;  but  not  from  the  testicles 
only,  for  the  preparation  should  also  contain  extracts  from  the 
prostate  as  well,  for  in  the  human  body  the  action  of  the  testicles 
is  inseparable  from  that  of  the  prostate.  This  has  been  shewn 
by  the  experiments  of  Camus  and  Gley,  who  found  that  seminal 
fluid  exhibits  more  lively  movement  of  the  spermatozoa  when  a 
little  prostatic  liquid  is  added  to  it.  It  is  thus  very  probable  that 
by  adding  prostatic  extracts  to  those  of  the  testicles,  the  vitality 
of  such  extracts  may  be  enhanced. 

It  is  important  to  note  that  in  his  article  on  old  age  in  Dr. 
Stedman's  well-known  work,  Boy-Teissier21  relates  that  he  ob- 
tained very  good  results  from  Brown-Sequard's  testicular  ex- 
tracts in  the  treatment  of  old  age. 

We  have  seen  in  Chapter  V  what  a  marvelous  influence  the 
sexual  glands  exercise  on  vitality  and  long  life;  if,  therefore, 
by  testicular  extracts  we  can  enhance  the  activity  of  the  sexual 
glands,  it  would  really  be  worth  while  to  do  so. 

In  addition  to  thyroid,  ovarian,  and  testicular  preparations, 
the  extracts  also  of  the  kidneys  should  give  good  results  in  the 
treatment  of  old  age  and  in  the  prevention  of  a  prematurely  aged 
condition,  by  improving  the  eliminative  functions  of  the  kidneys. 


21  "Twentieth  Century  Practice"  by  Thomas  Stedman,  M.D.,  London,  p.  491, 
1897. 


446  Old  Age  Deferred. 


It  has  been  found  by  many  authorities,  of  whom  we  espe- 
cially mention  Gilbert  and  Carnot,22  Obolenski,23  Dubois,24 
Renaut,25  and  Teissier,26  that  b}'  giving  extracts  of  the  kidneys 
they  were  able  to  improve  the  condition  of  patients  suffering 
from  various  forms  of  renal  diseases,  especially  when  suffering 
from  urasmic  conditions  and  parenchymatous  inflammations.  We 
have  also  tried  such  extracts  and  found,  indeed,  beneficial  results 
in  many  cases,  as  reported  in  an  address  we  gave  to  the  Medical 
Association  of  Greater  New  York  on  October  15,  1906.  Since 
then  we  have  had  opportunities  of  noting  similar  results  in  a  still 
greater  number  of  patients,  especially  in  aged  people,  among 
them  being  several  with  arteriosclerosis.  In  each  case  we  have 
observed  a  decrease  in  the  number  of  casts.  In  some  cases  of 
chronic  parenchymatous  nephritis  we  were  surprised  to  find  that 
there  were  no  casts  at  all,  after  several  weeks'  treatment  by  renal 
extracts — four  tablets  a  day — whereas,  before  treatment,  there 
were  found-  in  one  case  twenty  hyaline  and  granular  casts  in  one 
specimen  of  urine  only.  We  have  also  noticed,  in  many  cases,  a 
notable  diminution  of  albumin,  although  it  seems  to  us  that  the 
decrease  in  the  number  of  casts  has  been  more  prominent ;  and  in 
many  cases  there  has  been  an  increased  flow  of  urine. 

From  the  above  results  of  treatment  by  renal  extracts, 
such  a  treatment  Avith  extracts  prepared  by  maceration  of  the 
kidneys  of  pigs,  appears  indicated,  as  a  means  to  prevent  prema- 
ture old  age,  and  also  in  old  people  generally,  especially  since  we 
never  observed  any  deleterious  symptoms  after  administering 
two  to  four  tablets  a  day.  It  would,  possibly,  be  useful  to  recom- 
mend in  such  cases  pigs'  kidneys  daily ;  and  as  they  are  not  palat- 
able raw,  unless  tolerated  in  that  condition,  they  can  be  grilled. 

Good  effects,  and  probably  to  a  greater  degree,  may  be 
observed  also  after  the  use  of  pancreatic  extracts.     Their  use  in 


22  L'opotherapie,  Paris,  1898. 

23  Wratch,  No.  27,  1899. 

24  Soc.  de  biologie,  p.  2S7,  1903. 

25  Bull.  gen.  de  therapeutique,  p.  30.  1907. 

26  Teissier:    Bull.  Med.,  No.  57,  p.  617,  1907. 


Prevention  of  Premature  Old  Age  by  Animal  Extracts.    4  i  < 

old  age  is  indicated  by  the  fact  that  there  is  in  the  pancreas,  just 
as  there  is  in  the  kidneys  or  thyroid,  an  increase  of  connective 
tissue  in  old  age,  and  thus  the  pancreas  is  not  able  to  produce  the 
necessary  amount  of  ferments  for  the  digestion  and  assimilation 
of  the  proteid,  carbohydrate,  and  fat  food.  We  also  often  see, 
therefore,  aged  people  lose  weight,  especially  in  advanced  senility. 

According  to  the  observations  of  many  authorities,  among 
them  Abelmann,27  H.  Salomon,28  and  E.  Meyer,29  it  would 
seem  that,  by  the  use  of  certain  pancreatic  extracts,  there  is  a 
very  decidedly  better  assimilation  of  proteid,  of  amylaceous, 
and  especially  of  fatty  matters.  As  in  old  age  there  is  often  a 
decrease  of  stomach  and  pancreatic  juice,  pancreatic  extracts 
seem  to  be  especially  indicated. 

We  have  obtained  good  results  in  each  case  that  we  have 
treated  by  pancreatic  extracts,  and  also  in  experiments  on  our- 
selves, having  used  a  preparation  introduced  by  H.  Salomon. 
Even  in  aged  persons  we  have  noted  easier  digestion  and  the 
disappearance  of  digestive  trouble  after  two  or  three  tablets  of 
the  extract  of  pancreas  taken  immediately  after  dinner  and  supper. 
In  cases  of  liver  and  gall-stone  troubles,  where  previously  there 
was  a  considerable  loss  of  bodily  weight,  in  nearly  every  case 
after  pancreatic  treatment  there  was  no  more  falling  off  in  the 
weight,  and  in  some  instances  we  have  even  found  a  consider- 
able increase  in  weight.  It  is  our  custom  to  apply  these  extracts 
to  every  case  where  we  want  to  increase  bodily  weight  by  a 
better  assimilation  of  the  food.  Especially  in  cases  where  we 
have  given  much  milk  do  we  find  that  it  is  much  better  tolerated 
by  the  addition  of  these  extracts  to  the  food.  We  have  also 
found,  by  experiments  on  ourselves,  that  the  feeling  of  oppression 
and  heaviness  in  the  stomach  after  hearty  meals,  especially  of 
indigestible  food,  has  been  much  improved  by  the  use  of  two 


27 Abelmann:      Quoted  after  Oser,  Nothnagel's  "Practice"  p.   109;    "Dis- 
eases of  the  Pancreas,"  p.  101. 

28  Salomon:     Berl.  klin.  Wochenschrift,  Nu.  3,  1902. 

29  Meyer :     Zeitschrift  fiir  exper.  Path.  u.  Ther.,  vol.  ii,  3  H. 


r 

448  Old  Age  Deferred. 

to  three  of  these  pancreatic  tablets.  Especially  have  they  proved 
useful  after  late  dinners  in  preventing  a  disturbance  of  the  sleep. 
We  have  given  above  an  account  of  the  different  organic 
preparations  by  which  we  can  treat  the  symptoms  of  old  age 
with  good  results.  According  to  our  experience  it  is  not  advis- 
able to  use  all  these  extracts  at  one  and  the  same  time,  but  only  a 
few.  At  any  rate,  thyroid  tablets  can  be  used  for  a  long  time, 
but  in  every  case  with  intervals  between  the  treatment.  With 
these  ovarian  or  testicular  extracts  can  be  used,  as  can  also  pan- 
creatic extracts.  The  last  mentioned  ones  should  be  used  only 
as  long  as  necessary — until  digestion  is  improved  and  bodily 
weight  is  increased,  if  so  desired.  They  may  then  be  discarded 
until  again  needed.  Thyroid  extract  should  also  be  discarded, 
after  two  weeks'  or  one  month's  use,  for  a  week  or  so,  and  then 
slowly  begun  again.  It  is  difficult  to  give  general  instructions 
that  will  suit  every  case ;  it  is  therefore  best  to  treat  cases  in  an 
individual  manner,  the  prime  maxim  being  that  by  such  extracts 
the  function  of  certain  glands  should  be  improved  until  what 
was  defective  or  deficient  has  been  made  up.  The  thyroid  ex- 
tracts require  that  the  effects  should  be  carefully  watched ;  but  all 
the  other  extracts  are  free  from  harmful  consequences,  especially 
if  not  taken  in  abusive  doses,  and  provided  also,  of  course,  that 
they  are  fresh  and  not  decomposed  bv  long  keening. 


CHAPTER  LVII. 
A  Few  Hints  on  Youthful  Appearance. 

The  youthful  appearance  of  a  person  is  dependent  chiefly 
upon  the  condition  of  the  complexion,  of  theteeth  and  of  the  hair. 
If  a  person  has  a  fresh  complexion,  and  if  the  muscles  of  the 
face  are  firm  and  not  relaxed  his  face  will  show  a  youthful 
appearance.  A  few  wrinkles  around  the  eyes  and  the  crow-feet, 
which  we  find  especially  with  persons  of  a  vivid,  lively  disposi- 
tion, whose  faces  show  a  sensitive  expressiveness  do  not  prejudice 
the  youthful  appearance  of  such  persons. 

In  order  to  keep  the  complexion  fresh  and  to  protect  the 
skin  from  fading"  there  are  a  few  hygienic  measures  to  follow. 
It  is  not  advantageous  to  wash  the  face  daily  with  a  soap.  It  is 
much  better  to  dip  the  towel,  when  we  get  up,  in  cold,  soft  water, 
the  best  in  rain  water  and  then  to  wet  the  face  all  over,  or  to  bend 
over  a  basin  with  cold  rain  water  and  to  throw  with  the  hand  the 
water  against  all  parts  of  the  face.  Thus  by  the  refreshing  cold 
of  the  water  the  muscles  of  the  face  will  be  "toned  up"  and  their 
relaxation  prevented.  The  same  way  it  will  be  advisable  to  wet 
the  face  with  a  little  eau  de  cologne  or  alcohol  of  30  per  cent, 
whenever  fatigued  during  the  day  in  order  to  prevent  the  relaxa- 
tion of  the  muscles  of  the  face.  The  skin  of  the  face  should  be 
made  only  lightly  wet,  for  the  frequent  thorough  washing  of  the 
skin  will  tend  to  make  it  very  dry.  In  order  to  remove  the  dirt 
from  the  face  the  best  method  is  to  employ  a  very  mild  soap  which 
contains  much  fat.  It  is  advisable  to  put  on  the  face  in  the 
evening  before  going  to  bed  an  ointment  that  is  made  out  of 
animal  fat,  e.g.,  lanolin  to  which  may  be  added  glycerine  or  some 
other  kind  of  fat  of  animal  origin.    But  it  is  not  necessary  to  do 

this  every  day.     Massage  of  the  face,  by  which  the  blood  supply 

29  (449^ 


450  Old  Age  Deferred. 


of  the  muscles  can  be  augmented  may  be  of  great  benefit,  if  it  is 
done  in  a  scientific  way  and  carefully.  To  improve  the  complex- 
ion of  the  face  and  to  prevent  the  unsesthetic  reddish  skin  with 
dilated  blood-vessels,  the  tincture  of  benzoin  or  cosmetics  that 
contain  it  can  be  used  with  profit.  Those,  however,  who  are  so 
happy  as  to  have  a  naturally  fresh,  rosy  complexion  should  never 
use  benzoin,  for  according  to  our  observations  the  strong  tinc- 
tures made  with  it  may  be  detrimental  to  their  skin. 

Of  great  importance  to  the  freshness  of  the  complexion  is 
also  a  regular  daily  thorough  cleaning  of  the  intestines,  we  have 
often  made  the  observation,  that  the  yellowish  dark  complexion 
of  constipated  persons  gets  much  improved  after  a  copious 
evacuation ;  thus  in  this  sense  the  use  of  purgative  mineral  waters, 
and  also  the  use  of  laxative  fruits  like  grapes  taken  daily  in  large 
quantities  often  much  improve  the  complexion.  Then  also  the 
condition  of  the  liver  is  of  great  importance  for  a  fine  complexion, 
and  everything  that  improves  the  functions  of  the  liver  can  con- 
tribute to  conserve  the  same.  In  this  connection  we  refer  the 
reader  to  our  chapter  on  the  hygiene  of  the  liver. 

Of  great  use  also  are  bodily  exercises,  for  instance  long 
walks  in  the  open  air,  as  thus  the  circulation  of  the  blood  is  much 
improved  in  the  periphery  of  the  body  and  thus  also  is  the  face 
and  the  nutrition  of  the  tissues  of  the  skin  improved.  It  is  also 
of  importance  to  carefully  observe  our  teachings  on  the  rational 
hygienic  use  of  food  as  given  previously.  It  is  a  fact  that  the 
complexion  of  great  meat  eaters  is  not  so  fresh  and  finely  delicate 
as  that  of  persons  living  on  lacto-vegetable  foods.  We 
have  also  often  made  the  observation,  that  persons  eating  meat 
in  abundance  gain  a  better  complexion  after  having  been  put  on 
a  diet  of  milk,  eggs,  butter,  cereals  and  other  vegetable  foods, 
especially  abundance  of  fruit. 

It  is  also  a  fact  that  a  bright,  cheerful  disposition  favorably 
influences  the  expression  of  the  face  and  the  complexion.  Pas- 
sions, grief  and  sorrow  may  prove  very  detrimental,  as  they  often 
leave  lines  and  wrinkles  in  the  face. 


Youthful  Appearance.  451 

We  have  already  mentioned  previously  that  certain  drugs 
such  as  arsenic,  iron  and  iodides  can  prove  of  great  benefit  for 
the  production  of  youthful  looks,  as  they  powerfully  influence  the 
formation  of  the  blood  and  affect  its  circulation  through  the 
tissues,  and  also  the  general  nutrition.  Furthermore  the  thyroid 
preparations  can  bring  about  the  same  results  and  they  also  con- 
tribute to  obtain  and  retain  a  youthful  appearance  as  we  have 
shown  previously.  We  will  only  mention  here  the  important 
fact  that  wrinkles  in  the  face  are  of  frequent  occurrence  in 
degenerated  conditions  of  the  thyroid  gland ;  in  young  individuals 
and  even  in  infants  this  may  be  seen.  On  the  other  hand  may  be 
observed  the  disappearance  of  wrinkles  after  thyroid  treatment 
as  shown  in  our  chapter  on  the  treatment  of  old  age  through 
animal  extracts.  Hot  baths  are  also  useful  to  aid  in  retaining  a 
youthful  appearance  as  they  promote  a  better  circulation  of  the 
blood  through  the  tissues  of  the  skin  and  an  improvement  of 
the  functions  of  the  skin. 

Above  all  it  is  the  condition  of  the  teeth  that  is  of  utmost 
importance  for  youthful  looks.  For  if  they  fall  out  atrophy  of 
the  alveolar  process  takes  place,  and  when  the  lips  and  the 
cheeks  lack  their  osseous  support  they  will  fall  in.  The  chin  in 
consequence  gets  pointed,  the  height  of  the  face  is  diminished 
and  the  whole  face  looks  much  older.  To  avoid  this  everything 
should  be  done  to  keep  the  teeth  in  good  condition  and  to  prevent 
their  decay  and  their  falling  out. 

The  ruin  of  the  teeth  may  be  brought  about  by  external  and 
internal  causes.  The  first  are  less  dangerous,  for  they  are  chiefly 
of  bacterial  origin  and  they  can  be  avoided  by  a  scrupulous  clean- 
ing of  the  teeth.  Much  more  serious  and  sometimes  even 
unavoidable  are  the  internal  causes  thus  especially  the  bad  nutri- 
tion of  the  gums.  If  the  gums  are  not  sufficiently  supplied  with 
blood  or  if  the  blood  is  lacking  certain  important  elements,  or  if 
it  contains  elements  of  a  toxic  nature  as  for  instance  in  diabetes, 
they  become  atrophic.  They  retract  and  the  support  the  teeth 
receives  is  insufficient. 


452  Old  Age  Deferred. 


When  the  saliva  is  of  an  acid  nature  tartar  gets  deposited 
on  the  teeth  and  this  may  cause  the  formation  of  pus  in  the 
alveoli  of  the  teeth  i.e.,  produce  alveolar  pyorrhoea.  In  such  a 
condition  the  base  of  the  teeth  is  surrounded  by  pus,  which 
destroys  the  substance  of  the  teeth  which  are  then  lost.  Most 
frequently  we  find  an  acid  saliva  in  meat  eaters  and  in  certain 
diseases,  especially  in  diabetes,  gout,  etc.  According  to  Paterson 
the  above  condition  is  very  frequent  in  persons  with  chronic  nasal 
and  pharyngeal  catarrhs,  especially  when  breathing  through  the 
mouth. 

The  best  means  to  obtain  a  regular  supply  of  blood  to  the 
gums  is  the  massage  of  the  gums  by  the  finger,  on  which  may  be 
put  a  little  olive  oil,  and  then  gently  rub  the  lower  jaw  from 
below  upwards,  and  the  upper  jaw  from  above  downwards. 
Equally  a  rubbing  of  the  teeth  with  a  brush  that  is  put  in  an 
alcoholic  solution  of  30  per  cent,  will  do  good.  The  acid  saliva 
can  be  remedied  by  an  alkaline  mouth  water,  or  a  paste  containing 
bicarbonate  of  sodium  in  large  quantities.  It  is  also  very  benefi- 
cial to  the  gum  to  clean  it  with  alcohol  of  30  per  cent,  gargling 
or  drawing  it  between  the  teeth,  as  is  also  the  use  of  certain 
antiseptic  and  stringent  mouth  waters  like  borax  with  tincture 
of  myrrh,  or  ratanhia  with  myrrh,  etc.  Hydrogen  peroxide  is  an 
ideal  antiseptic  for  the  teeth  and  gums,  and  in  strong  solution  it 
may  prove  useful  in  cases  of  a  hypersemic  and  inflamed  condition 
of  the  gum. 

The  condition  of  the  sexual  glands  and  of  the  thyroid  gland 
also  powerfully  influence  the  condition  of  the  teeth,  which  can 
be  seen  plainly  by  the  fact  that  all  the  alterations  of  these  glands, 
as  in  pregnancy,  in  chlorotic  conditions,  etc.,  may  produce 
important  changes  in  the  condition  of  the  teeth  and  the  alveolary 
processes.  In  some  cases  we  were  able  to  improve  a  swelled  and 
hypersemic  condition  of  the  gum  by  the  administration  of  thyroid 
extracts. 

Youthful  looks  also'  very  much  depend  upon  the  condition 
of  the  hair.    When  the  hair  is  scarce  and  what  there  is  left  is  gray 


Youthful  Appearance.  453 

a  person  appears  much  older  than  he  really  is.  When  we  get  to 
a  certain  age — and  many  persons  even  before — the  connective 
tissue  in  the  capillaries  which  provide  the  hair  root  with  blood 
becomes  augmented  and  the  elasticity  of  their  walls  become  lost. 
Thus  there  will  be  a  difficulty  in  the  regular  blood  supply  to  the 
hair  roots  or  bulbs.  We  have  already  in  these  pages  insisted  on 
the  fact  that  iodides  are  able  to  improve  the  circulation  of  the 
blood  in  the  capillaries  and  thus  they  may  give  good  results  in 
such  cases,  especially  in  aged  persons.  We  may  also  improve  the 
blood  circulation  by  massage  of  the  scalp  done  in  a  gentle  way 
and  carefully.  According  to  Ehrmann  the  faradization  of  the 
hair  gives  also  good  results.  Above  all  we  should  not  make  diffi- 
cult the  blood  supply  to  the  hair  roots  by  the  wearing  of  hard 
stiff  hats  which  compress  the  blood-vessels.  Less  often  the 
falling  out  of  the  hair  is  caused  by  bacterial  diseases  and  such 
can  be  best  combated  by  antiseptic  ointments  by  sublimate, 
alcohol,  by  washing  with  tar  soap,  etc. 

There  exists  here  also  a  sympathetic  connection  between  the 
condition  of  the  hair  and  that  of  the  thyroid  and  the  sexual 
glands.  In  the  degenerated  conditions  of  these  glands  we 
frequently  find  the  hair  very  spare,  it  remains  short,  dry  and 
brittle  and  falls  out  very  easily.  After  having  treated  such  cases 
for  a  certain  time  with  thyroid  extracts,  we  can  obtain  often  a 
great  improvement  in  the  condition  of  the  hair.  It  may  in  the 
beginning  fall  out  the  more,  but  this  happens  only  with  hair  that 
is  already  morbidly  decayed,  but  afterwards  we  will  observe  a 
still  better  growth  of  new  hair.  Arsenic  may  also  give  similar 
results  according  to  our  own  observations  and  that  of  other 
authorities. 

Youthful  looks  can  also  be  obtained  by  a  slender  figure. 
Slender  persons  look  often  younger  than  they  are,  whereas 
corpulency  conveys  more  the  impression  of  a  higher  age  than 
would  correspond  to  the  real  number  of  years.  Therefore  those 
who  wish  to  look  young  must  avoid  becoming  corpulent.  Above 
all  the  quantity  of  meat  should  be  limited,  for  corpulency  can  be 


454  Old  Age  Deferred. 


best  brought  about  by  much  meat  in  the  diet,  if  at  the  same  time 
also  amylaceous  or  starchy  foods  and  sweets  are  taken  in  quantity. 
Besides  a  frugal  diet,  much  exercise  contributes  in  most  persons 
to  the  prevention  of  obesity.  Turkish  baths,  and  according 
to  the  prevalent  opinion,  also  the  use  of  certain  purgative  mineral 
waters  like  those  of  Carlsbad,  Marienbad  or  Kissingen  will  also 
give  good  results.  Very  often  we  can  see  good  results  with  a 
great  loss  in  the  weight  of  corpulent  persons  after  the  use  of 
thyroid  preparations  as  we  have  mentioned  previously. 


CHAPTER  LVIII. 

The  "Twelve  Commandments"  for  the  Preservation  of 
Youth,  and  the  Attainment  of  a  Green  Old  Age. 

In  his  report  on  the  autopsy  of  Thomas  Parr,  who  lived 
to  the  age  of  152  years  and  9  months,  Dr.  Harvey,  physician  to 
the  king,  attributed  his  death  to  the  change  from  a  frugal  diet 
of  subrancid  cheese,  milk  in  every  form,  and  coarse,  hard  bread, 
to  the  rich  feeding  he  received  in  London,  and  to  the  change 
from  the  healthy  air  of  the  country  to  the  foggy  climate  of  the 
metropolis.  We  also  dwelt  on  the  important  fact  that  by  his 
leading  such  a  peasant's  life,  free  from  care  owing  to  its  sim- 
plicity it  contributed  to  his  very  advanced  age ;  for,  as  the  great 
Harvey  pithily  put  it,  "sorry  fare,  but  free  from  care." 

We  thus  see  that  this  celebrated  discoverer  of  the  circulation 
of  the  blood  ascribed  special  importance,  for  the  attainment  of  an 
advanced  old  age,  to  these  same  agencies,  viz. :  living  temperately 
and  in  the  open  air,  and  absence  from  worry,  the  importance  of 
which  we  have  demonstrated  by  scientific  evidence  in  the  various 
chapters  of  this  book. 

We  have  found,  among  the  cases  of  those  who  lived  to  a 
great  age,  sometimes  much  over  one  hundred  years,  very  .numer- 
ous instances  of  persons  who  were  in  poor  circumstances,  exist- 
ing on  a  very  simple  diet,  but  who  were  free  from  cares.  To 
attain  such  a  measure  of  simple  diet  does  not  require  any  very 
great  effort  of  mind ;  peasants  obtain  it  without  care  or  worry. 
If  we  were  asked  for  the  best  means  of  living  to  be  100  years 
old  we  would  say :  become  a  peasant  or  a  pauper  and  be  received 
into  an  English  work-house. 

It  is  astonishing  how  many  of  the  inmates  of  the  Eng- 
lish workhouses  and  other  similar  institutions  for  the  poor  be- 
come very  aged.     They  have  no  anxieties  about  getting  their 

(455) 


456  Old  Age  Deferred. 


daily  bread,  and  oftentimes  they  are  fed  better  than  they  would 
have  been  in  their  homes,  although  only  the  minimum  amount 
of  hygienic  food  is  given.  (This  certainly  would  not  have  ap- 
plied to  the  English  workhouses  before  the  days  of  Charles 
Dickens.)  Workhouse  inmates  lead  a  very  regular  and  frugal 
life,  rising  in  the  small  hours  of  the  morning  and  retiring  to  bed 
early  in  the  evening.  Thus,  in  winter  time,  they  can  never  con- 
tract pneumonia  by  coming  home  late  from  the  overheated  theatre, 
concert,  or  club-house.  They  also  need  not  worry  about  their 
fortunes,  for  they  have  none. 

We  may  thus  conclude  that  a  workhouse  may  be  a  more 
favorable  place  for  reaching  a  good  old  age  than  a  palace,  which 
coincides  with  the  pithy  words  of  Dr.  Harvey  already  quoted. 

To  the  three  agencies  of  frugality,  fresh  air,  and  no  worries 
we  would  like  to  add  the  great  advantage  of  sunshine,  plenty 
of  milk  in  the  diet,  and  little  meat,  a  daily  proper  action  of  the 
bowels,  a  daily  bath,  rational  clothing,  and  above  all — con- 
sidering the  great  importance  of  the  functions  of  the  glands  with 
internal  secretion  as  a  means  of  freeing  our  body  from  poison- 
ous products,  and  thus  preventing  premature  old  age — we  must 
insist  on  the  rational  hygiene  of  these  organs,  and  on  the  rein- 
forcement of  their  functions,  if  changed  by  age  or  disease,  by 
means  of  extracts  obtained  from  similar  organs  of  healthy 
animals. 

From  long  study  of  the  lives  of  the  patriarchs  of  great  age — 
who,  according  to  evidence,  sometimes  legal,  and  acknowledged 
also  by  such  authorities  as  Professor  Pfliiger1  and  Pel,2  have 
attained  an  age  much  over  ioo,  and  in  some  cases  even  of  160 — 
we  have  come  to  the  conclusion  that,  by  following  the  hygienic 
rules  we  have  laid  down  in  the  various  chapters  in  this  book,  we 
certainly  can  preserve  our  youthfulness  till  50  or  60,  and  our 
life  to  100  or  over. 

We  fully  acknowledge  the  value  of  descent  from  long-lived 


1  Loo.  cit. 

2  Pel:    Log.  cit. 


"Twelve  Commandments"  for  a  Green  Old  Age.        457 

families,  but  we  may  refer  to  the  instances  we  have  quoted  of 
persons  descended  from  short-lived  families  and  yet  living  to  be 
nearly  ioo. 

It  would,  indeed,  be  most  foolish  to  feel  like  an  old  man  or 
woman  when  but  40  or  50,  and  to  die  perhaps  at  60,  when,  by  the 
exercise  of  a  little  judgment,  we  can  considerably  prolong-  our 
youth,  which  may  otherwise  be  fast  flitting  away,  preparing  us  for 
an  early  grave,  and  enjoy  our  life  twice  as  much  by  being  free 
from  pains  and  ailments. 

Most  of  the  evils  that  befall  us  in  this  world,  including 
premature  old  age  and  early  death,  are,  in  our  opinion,  as  we 
have  often  repeated,  solely  due  to  our  own  negligence ;  and  to 
avoid  such  a  fate  we  recommend  the  following  precepts : — 

1.  To  be  as  much  as  possible  in  the  open  air,  and  especially 
in  the  sunshine ;  and  to  take  plenty  of  exercise,  taking  special 
care  to  breathe  deeply  and  regularly. 

2.  To  live  on  a  diet  consisting  of :  meat  once  a  day,  eggs, 
cereals,  green  vegetables,  fruit,  and  raw  milk  of  healthy  cows 
(as  much  as  the  stomach  will  permit)  ;  and  to  masticate  properly. 

3.  To  take  a  bath  daily;  and  in  addition,  once  a  week  or 
once  every  two  weeks,  to  take  a  sweat  bath  (if  the  heart  can 
stand  it). 

4.  To  have  a  daily  action  of  the  bowels ;  and  in  addition  to 
take  a  purgative  once  a  week  if  there  is  any  tendency  to 
constipation. 

5.  To  wear  very  porous  underwear,  preferably  cotton; 
porous  clothing,  loose  collars,  light  hat  (if  any),  and  low  shoes. 

6.  To  go  to  bed  early,  and  to  rise  early. 

7.  To  sleep  in  a  very  dark  and  very  quiet  room,  and  with 
a  window  open ;  and  not  to  sleep  less  than  six  to  six  and  one-half 
hours,  or  more  than  seven  and  one-half,  and  for  women  eight 
and  one-half,  hours. 

8.  To  have  one  complete  day's  rest  in  each  week,  without 
even  reading  or  writing. 

9.  To  avoid  mental  emotions,  and  also  worries  about  things 


458  Old  Age  Deferred. 


that  have  happened  and  cannot  be  altered,  as  well  as  about  things 
that  may  happen.  Never  to  say  unpleasant  things,  and  to  avoid 
listening  to  such,  if  possible. 

10.  To  get  married;  and  if  a  widow  or  widower,  to  marry 
again ;  and  to  avoid  sexual  activity  beyond  the  physiological  limit, 
as  also  to  avoid  a  total  suppression  of  the  functions  of  these 
organs. 

ii.  To  be  temperate  in  the  use  of  alcohol  and  tobacco,  and 
also  in  the  use  of  coffee  or  tea. 

12.  To  avoid  places  that  are  overheated,  especially  by  steam, 
and  badly  ventilated.  To  replace  or  reinforce  the  functions  of 
the  organs  which  may  have  become  changed  by  age  or  disease, 
by  means  of  the  extracts  from  the  corresponding  organs  of 
healthy  animals ;  but  only  to  do  this  under  the  strict  supervision 
of  medical  men  who  are  thoroughly  familiar  with  the  functions 
of  the  ductless  glands. 


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